title: Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels.
abstract: BACKGROUND
  Angiotensin 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  After 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.
  
  
  CONCLUSIONS
  Since 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.
authors.forename: Adnan
authors.initials: A
authors.lastname: Ajmal
authors.forename: Charles E
authors.initials: CE
authors.lastname: Gessert
authors.affiliation: Essentia Institute of Rural Health, Duluth, MN, USA. BJohnson3@eirh.org.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Johnson
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Renier
authors.forename: Jeanette A
authors.initials: JA
authors.lastname: Palcher
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins