title: Angiotensin-converting enzyme inhibitors slow recovery from anemia following cardiac surgery.
abstract: OBJECTIVE
  Angiotensin-converting enzyme (ACE) inhibitors, which are frequently administered in patients with heart disease, have a known inhibitory effect on erythropoiesis. The aim of this study was to detect whether early ACE inhibitor administration slows recovery from anemia following recent cardiac surgery.
  
  
  RESULTS
  Forty male patients with anemia (hemoglobin < 12 g/dL) an average of 9 days after cardiac surgery were randomized to receive enalapril (ACE inhibitor group) or not. All of the patients received ferrous sulfate, 525 mg, in addition to standard therapy. Patients with anemia due to other causes were excluded. Blood samples were obtained at baseline, and after 8 days, 16 days, and 60 days. A 6-min walking test and echocardioscan were performed at baseline, and after 16 days and 60 days of treatment, and a chest radiograph was obtained at baseline and after 60 days. The ACE inhibitor group showed a statistically significant lower increase in hemoglobin and RBC values. The peak between-group differences of 1 g/dL of hemoglobin (p = 0.012) and 444 RBCs per milliliter (p = 0.017) were observed on day 16.
  
  
  CONCLUSIONS
  Early enalapril maleate administration in anemic patients after heart surgery significantly inhibits erythropoiesis. This unfavorable effect on anemia should be considered when prescribing ACE inhibitors for such patients.
authors.affiliation: Unità Operativa Cardiologia Rehabilitativa, IRCCS S. Maria Nascente Fondazione Don C. Gnocchi, Milan, Italy.
authors.forename: Vittorino
authors.initials: V
authors.lastname: Ripamonti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Racca
authors.forename: Maria G
authors.initials: MG
authors.lastname: Calvo
authors.forename: Paolo
authors.initials: P
authors.lastname: Castiglioni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferratini
mesh_terms: D000740:Anemia / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D004656:Enalapril / Q000009:adverse effects* / Q000627:therapeutic use; D004920:Erythropoiesis / Q000187:drug effects*; D006454:Hemoglobins / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins; D004656:Enalapril