Should all patients with peripheral arterial disease be treated with an angiotensin-converting enzyme inhibitor?

Peripheral arterial disease (PAD) is a marker of advanced atherosclerosis with an elevated risk of cardiovascular mortality and morbidity. The modification of risk factors to improve the outcomes of patients with coronary artery atherosclerosis is proven and has become an accepted standard of care that is widely followed. Recent evidence from randomized controlled clinical trials has demonstrated the effectiveness of angiotensin-converting enzyme inhibitors as an important risk reduction therapy for patients with PAD. This therapy has yet to become well recognized and implemented in the PAD population. This article reviews the evidence that supports the use of angiotensin-converting enzyme inhibitors in patients with PAD to reduce the burden of the associated cardiovascular morbidity and mortality in this high-risk population.