Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels

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.

Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

“…Meanwhile, considering the association between anemia and albuminuria, it can be hypothesized that recognizing of patients with albuminuria and the use of interventions such as angiotensin converting enzyme inhibitors (ACEI) or an angiotensin receptor blocker (ARB) may lead to the improvement of anemia. However, ACEI has been suggested as causing anemia in several studies rather than improving anemia [ 31 , 32 ]. In a retrospective analysis from electronic health record data of 701 patients receiving ACEI or an ARB, the use of ACEI was associated with decreased hemoglobin levels compared with an ARB [ 31 ].…”

Renin‐angiotensin system blockade promotes a cardio‐renal protection in albuminuric homozygous sickle cell patients

“…Moreover, despite a low basal systemic blood pressure, and a significant ACEI decrease of diastolic and mean blood pressure, no symptomatic hypotension was recorded but three individuals did interrupt the treatment for vertigo, with one successfully switched to angiotensin II receptor blockers; two who refused the switch. One concern prior to the initiation of the study was a potential ACEI‐mediated worsening of pre‐existing anaemia (Ajmal et al , ). As a matter of fact, haemoglobin level decrease was significant but mild in all patients, with no reported clinical symptoms or events.…”

Haematopoietic effects of Angelica sinensis root cap polysaccharides against lisinopril-induced anaemia in albino rats

“…ACEIs may aggravate anaemia by decreasing Ang II levels that have an association with clinical management of chronically ill patients (Cole et al 2000;Hayashi et al 2001). Anaemia contributes to the worsening of cardiovascular diseases in many cases, therefore, the management of anaemia is necessary for controlling the patient's overall condition (Ajmal et al 2013). The link between chronic heart failure and anaemia may be associated with high mortality (Anand et al 2004).…”

“…However, prolonged use of these medications is reported to cause anaemia (Ajmal et al 2013). ACEIs reduced erythropoietin (EPO) levels, circulating insulin-like growth factor (IGF-1) and haematocrit.…”