A low ankle brachial index strongly predicted the primary outcome (18.2% for ABI 0.6-0.9 vs 13.1% for ABI >0.9; P<0.0001), and ramipril prevented major cardiovascular events in these patients.
RCT (n=8,986)
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 (0.9:13.1%, 0.6-0.9: 18.2% and 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.
Jan Östergren (Sat,) conducted a rct in Peripheral arterial disease (n=8,986). Ramipril vs. Placebo was evaluated on Major cardiovascular events. A low ankle brachial index strongly predicted the primary outcome (18.2% for ABI 0.6-0.9 vs 13.1% for ABI >0.9; P<0.0001), and ramipril prevented major cardiovascular events in these patients.