title: Introduction of angiotensin-converting enzyme inhibitors induces a fall in hemoglobin levels in elderly patients hospitalized with heart failure: a cohort study.
abstract: OBJECTIVE
  Although the use of angiotensin-converting enzyme-inhibitors (ACE-I) is a cornerstone of treatment for heart failure (HF), these agents have been associated with decreasing hemoglobin levels in several settings. The aim of this study was to assess whether ACE-I are associated with decreasing hemoglobin in older subjects, and whether this effect is enhanced among patients with HF.
  
  
  METHODS
  The association between starting use of ACE-I and variations in hemoglobin levels was investigated in 10,354 hospitalized elderly, 1217 of whom had a verified diagnosis of HF, enrolled in a multicenter pharmacoepidemiology survey.
  
  
  RESULTS
  According to Cox regression analysis, the relative risk of a decrease in hemoglobin levels >0.5 g/dL associated with starting treatment with ACE-I was 1.12 (95% CI 0.98-1.26, p=0.081) among participants without HF, and 1.98 (95% CI 1.54-2.53, p<0.0001) among patients with HF, after adjusting for potential confounders. Analysis of the interaction term in Cox regression confirmed that the association between use of ACE-I and hemoglobin decrease varied according to diagnosis of HF (p=0.003) and older age (p=0.029).
  
  
  CONCLUSIONS
  Starting treatment with ACE-I is independently associated with increased risk of hemoglobin decrease among older hospitalized patients with HF. Hemoglobin levels should be monitored in older subjects who start ACE-I.
authors: Department of Gerontology and Geriatrics, Catholic University of Medicine, L.go F. Vito 1, 00168 Rome, Italy. lavoralice@gmail.com
authors: Alice
authors: A
authors: Laudisio
authors: Emanuele
authors: E
authors: Marzetti
authors: Francesco
authors: F
authors: Pagano
authors: Roberto
authors: R
authors: Bernabei
authors: Giuseppe
authors: G
authors: Zuccalà
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D008297:Male; D017891:Pharmacoepidemiology / Q000379:methods; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins