Abstract
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.
Abbreviations and Acronyms:
ACE-I (angiotensin-converting enzyme inhibitor), ARB (angiotensin II receptor blocker), CCB (calcium channel blocker), Hb (hemoglobin), IHD (ischemic heart disease), MHS (Maccabi Healthcare Services), OR (odds ratio), PDC (proportion of days covered), WHO (World Health Organization)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 09, 2012
Footnotes
Grant Support: This study was supported by internal department funds.
Identification
Copyright
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
