Clinical and Cost Effectiveness of ACE Inhibitor, Ramipril, in Intermittent Claudicants

Inclusion Criteria: * Patients with unilateral or bilateral intermittent leg claudication which was stable for the last 6 months. * Patients with ABPI \< 0.9 at rest at least in one leg. * BP ≤ 160/90 and a stable medication regimen for the last 6 months. * Able to give informed consent * Able to comply with study protocol Exclusion Criteria: * Documented bilateral renal artery stenosis * Unlikely to be compliant with medication or follow up as determined by the recruiting institution. * Pregnancy * Patients with critical limb ischemia (This includes patients with ischaemic rest pain and ulceration \> 2 weeks and/or a resting ankle pressure \< 50mmHg- Grades II and III according to Rutherford et al 1997.\[56\]. * Patients who had a recent (less than 3 months) angioplasty or bypass surgery * Patients who are unable to perform a treadmill test due to a limiting heart, respiratory or arthritic disease * History of angioneurotic oedema * Currently taking ACE inhibitor or Angiotensin receptor blocker * Contraindication to ACE inhibitor * History of ACE inhibitor intolerance * A creatinine rise of \> 30% from baseline and/or Potassium \> 5.9 mmol/l * Unwillingness to participate. * Level 1 evidence for ACE inhibitor treatment, including: * Documented heart failure, left ventricular dysfunction or ejection fraction \<35% on previous echocardiography * Uncontrolled hypertension, BP \> 160mmHg systolic or 100mmHg diastolic on 3 separate readings measured after 10 minutes rest on 2 separate occasions * Recent (\< 3months) myocardial infarction or stroke * Chronic renal impairment (serum creatinine \> 250 micromol/l)