Copyright © 2004 by the European Society of Cardiology.
Clinical research
Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease
a Department of Medicine, Karolinska Hospital, Stockholm, Sweden
b Department of Cardiovascular Medicine John Radcliffe Hospital, Oxford, UK
c Department of Medicine, University of Montreal, Montreal, Canada
d Department of VA Medical center, Muskogee, Oklahoma, USA
e Division of Cardiology, McMaster University, Hamilton General Hospital, Hamilton, Canada
* Correspondence to: Dr J. B. Östergren, Karolinska Hospital, Division of Emergency Medicine, Department of Medicine, 171 76 Stockholm, Sweden. Tel: +46 8 51775473; Fax: +46 8 318264
E-mail address: jan.ostergren{at}ks.se
Received 25 June 2003; revised 21 October 2003; accepted 29 October 2003
Abstract
Aims The aim of this study was to assess the prognostic importance of peripheral arterial disease (PAD) as evaluated by ankle blood pressure index (ABI), and the impact of ramipril on the prevention of major cardiovascular events in PAD patients included in the Heart Outcomes Prevention Evaluation (HOPE) study.
Methods and results Patients were randomized to treatment with ramipril or placebo and followed for 4.5 years. Ankle brachial blood pressure index was measured, mainly by digital palpation of the foot pulse, at baseline in 8986 patients. The ABI was subnormal (
0.9) in 3099 patients and normal in 5887 patients. A low ABI was a strong predictor of morbidity and mortality during the follow-up even in patients with no clinical symptoms of PAD (n=6769). This was so for the primary outcome of the study; ABI>0.9:13.1%, 0.6–0.9: 18.2% and <0.6: 18.0% (P<0.0001) and for mortality from all causes: in those with a normal ABI it was 8.5%, in those with ABI >0.6–0.9, 12.4% and 14.2% in those with an ABI lower than 0.6 (P<0.0001). Ramipril reduced the risk of clinical outcomes in those with a clinical history of PAD as well as in the patients with subclinical PAD.
Conclusions The ABI even if measured simply by palpation of the foot arteries is a strong predictor for future cardiovascular events and for all-cause mortality. Ramipril prevented major cardiovascular events in patients with clinical as well as subclinical PAD.
Key Words: Blood pressure • Peripheral vascular disease • Cardiovascular diseases • Ankle blood pressure • Risk factors
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