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

Shahin, Yousef; Barnes, Rachel; Barakat, Hashem; Chetter, Ian C.

Abstract

Objective
The 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).

Methods
MEDLINE, 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.

Conclusion
Treatment 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.

Citation

Shahin, Y., Barnes, R., Barakat, H., & Chetter, I. C. (2013). Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication. Atherosclerosis, 231(2), 283-290. https://doi.org/10.1016/j.atherosclerosis.2013.09.037

• Journal Article Type: Article
• Acceptance Date: Dec 1, 2013
• Publication Date: 2013-11
• Journal: Atherosclerosis
• Print ISSN: 0021-9150
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 231
• Issue: 2
• Pages: 283-290
• DOI: https://doi.org/10.1016/j.atherosclerosis.2013.09.037
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://hull-repository.worktribe.com/output/432578
• Additional Information: This article is maintained by: Elsevier; Article Title: Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication; Journal Title: Atherosclerosis; CrossRef DOI link to publisher maintained version: http://dx.doi.org/10.1016/j.atherosclerosis.2013.09.037; Content Type: article; Copyright: Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.