Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication

Abstract

ObjectiveThe aim of this meta-analysis was to investigate the effect of angiotensin converting enzyme (ACE) inhibitors on maximum walking distance (MWD), pain-free walking distance (PFWD) and ankle brachial pressure index (ABPI) in patients with intermittent claudication (IC). MethodsMEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to July 2013 on randomised controlled trials (RCTs) that assessed the effect of ACE inhibitors on MWD, PFWD and ABPI in patients with IC. ResultsOf 348 publications found, a meta-analysis was conducted of 6 RCTs comprising 821 patients. Treatment with ACE inhibitors improved MWD by mean difference (95 per cent confidence interval) of 120.8 (2.95–238.68) m (P = 0.040), improved PFWD by 74.87 (25.24–124.50) m (P = 0.003) and insignificantly improved ABPI by 0.07 (−0.02–0.17) (P = 0.110) compared to placebo. Heterogeneity across studies was significant. Maximum treatment benefit was achieved after a 6-months treatment period with ramipril as the ACE inhibitor. ConclusionTreatment with ACE inhibitors improved walking ability in patients with IC. However, this was not associated with significant improvement in ABPI. Patients with IC might benefit from treatment with a high tissue affinity ACE inhibitor for a period of 6 months.