Impact of ACEI/ARB initiation on haemoglobin in routine care

  • Greenhall GHB & al.
  • Br J Clin Pharmacol
  • 12 Jun 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Initiation of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEI/ARB) treatment is associated with a modest increase in the risk of a haemoglobin reduction compared with initiation of a calcium channel blocker (CCB).

Why this matters

  • Findings may have implications for drug choice and monitoring for many patients in primary care.
  • Future studies could identify patients at a higher risk of this adverse outcome, who may benefit from closer monitoring.

Study design

  • This national cohort study included 136,655 patients starting treatment with ACEI/ARBs (n=86,652) or CCBs (n=59,958) using routine primary care data from the UK Clinical Practice Research Datalink (CPRD).
  • Primary outcome: ≥1 g/dL haemoglobin reduction in the 6 months after drug initiation.
  • Funding: None disclosed.

Key results

  • Haemoglobin level reduced by ≥1 g/dL after drug initiation in 19.5% (16,936/86,652) of ACEI/ARB initiators and 15.9% (9521/59,958) of CCB initiators.
  • The incidence of anaemia (haemoglobin
  • The fully adjusted OR of a ≥1 g/dL haemoglobin reduction and incident anaemia in ACEI/ARB initiators compared with CCB initiators was 1.15 (95% CI, 1.12-1.19) and 1.12 (95% CI, 1.07-1.17), respectively.
  • Absolute haemoglobin reduction was 0.05 g/dL (95% CI, 0.04-0.06) greater in ACEI/ARB than CCB initiators.

Limitations

  • Risk of residual confounding.
  • Results may have limited generalisability.