Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels

Adnan Ajmal, Charles E. Gessert, Brian P. Johnson, Colleen M. Renier, Jeanette A. Palcher

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


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.

Original languageEnglish (US)
Article number443
JournalBMC Research Notes
Issue number1
StatePublished - 2013
Externally publishedYes

Bibliographical note

Funding Information:
This research was supported by a grant from the Essentia Institute of Rural Health’s Scientific Review Board, 502 E 2nd Street, Duluth, MN 55805-1983.


  • Anemia
  • Angiotensin converting enzyme inhibitors (ACEIs)
  • Angiotensin receptor blockers (ARBs)
  • Chronic kidney disease (CKD)
  • Hemoglobin


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