Abstract
BackgroundAngiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the management of congestive heart failure (CHF), diabetes mellitus (DM) and hypertension (HTN). Use of these agents is reported to cause anemia.MethodsWe examined the association between standard care use of ACEI or ARB and subsequent change in hemoglobin (Hgb) in a population of 701 adult primary care patients with DM, CHF and/or HTN. Data analysis was conducted to adjust for baseline differences between the treatment groups.ResultsAfter adjusting for differences in covariates at baseline between the subjects who were prescribed ACEI (N = 519) and ARB (N = 182), as well as the associated odds of being prescribed ARB, the ACEIs were associated with lower mean Hgb [0.18 (0.02, 0.34) g/dL, p = 0.02] at follow up relative to ARBs. However, patients with CHF experienced an increase in Hgb while on treatment (0.42 g/dL), especially those treated with ACEIs (0.56 g/dL). Chronic kidney disease at baseline was not associated with a significant decrease in Hgb in either treatment group.ConclusionsSince ACEIs and ARBs are most frequently used in patients who are vulnerable to complications from anemia, such as patients with CHF, HTN and DM, these findings may be useful to clinicians in selecting medications and monitoring patients for the adverse effects of treatment.
Highlights
Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the management of congestive heart failure (CHF), diabetes mellitus (DM) and hypertension (HTN)
ACEI use has been found to be associated with a decrease in erythropoietin concentrations after as little as 28 days; [12] in this study follow up Hgb was assessed in the 3 to12 month window following the initiation of therapy
The estimated effects of baseline demographic and clinical characteristics on follow up hemoglobin are summarized in Table 2, both for the entire population studied (N = 701), and for the ACEI (N = 519) and ARB (N = 182) populations separately
Summary
Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the management of congestive heart failure (CHF), diabetes mellitus (DM) and hypertension (HTN). Use of these agents is reported to cause anemia. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are antihypertensive drugs that are in wide use for indications in addition to the control of hypertension [1,2] This wide use is largely due to their renoprotective and cardioprotective effects in patients with diabetes mellitus (DM) and congestive heart failure (CHF). The “Anemia Correction in Diabetes” (ACORD) trial demonstrated that correction of anemia prevented an additional increase in left ventricular mass, and was associated with a significant improvement in quality of life [8]
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