Document Detail

Association of angiotensin-converting enzyme inhibitor therapy initiation with a reduction in hemoglobin levels in patients without renal failure.
MedLine Citation:
PMID:  23141116     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate whether treatment initiated with an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) for patients with ischemic heart disease, hypertension, or diabetes causes a reduction in hemoglobin (Hb) levels.
PATIENTS AND METHODS: This was a retrospective cohort analysis using the computerized database of a large health maintenance organization. Included were all adults with a first purchase of an ACE-I, an ARB, or a calcium channel blocker (CCB) between January 1, 2004, and December 31, 2009, defined as the index date. Measures of Hb levels before and 1 year after the index date were reviewed, and the change was calculated. All the analyses were stratified by pharmaceutical class. The main exposure variables were the proportion of days covered (PDC) by these drugs and the mean enalapril dosage (for enalapril users only).
RESULTS: Levels of Hb before and after treatment were available for 14,754 patients taking ACE-Is, 751 taking ARBs, and 3087 taking CCBs. A high PDC was significantly associated with greater yearly reductions in Hb levels compared with a low PDC for CCB use, but was more pronounced for ACE-I and ARB use. A high PDC was also associated with a higher odds of developing anemia in ACE-I users (odds ratio [OR], 1.59; P<.001) and ARB users (OR, 2.21; P=.05). In nonanemic enalapril users, every 10-mg increment in daily dose was associated with an OR of 1.45 for the development of anemia (P<.001). The association remained after excluding nonadherent patients.
CONCLUSION: Levels of Hb are reduced during the first year of use of ACE-Is and to a lesser extent with use of ARBs. This association is dose dependent and is not explained by patient adherence.
Eran Leshem-Rubinow; Arie Steinvil; David Zeltser; Shlomo Berliner; Ori Rogowski; Raanan Raz; Gabriel Chodick; Varda Shalev
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-11-07
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  87     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-03-12     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  1189-95     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Angiotensin Receptor Antagonists / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Calcium Channel Blockers / therapeutic use
Cohort Studies
Diabetes Mellitus / drug therapy
Dose-Response Relationship, Drug
Enalapril / therapeutic use
Hemoglobins / analysis*,  drug effects*
Hypertension / drug therapy
Logistic Models
Medication Adherence
Middle Aged
Myocardial Ischemia / drug therapy
Retrospective Studies
Reg. No./Substance:
0/Angiotensin Receptor Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Calcium Channel Blockers; 0/Hemoglobins; 69PN84IO1A/Enalapril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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