Key result
Irbesartan decreases erythropoietin and hemoglobin levels vs fosinopril in essential hypertension.
Why the study?
The comparative effects of angiotensin receptor blocker irbesartan and angiotensin converting enzyme inhibitor fosinopril on erythropoiesis in essential hypertensive patients with normal renal function were unclear.
Does irbesartan compared to fosinopril affect erythropoiesis in essential hypertensive patients with normal renal function?
RCT (n=30)
randomized
Does irbesartan compared to fosinopril affect erythropoiesis in essential hypertensive patients with normal renal function?
Absolute Event Rate: 18.1% vs 18.6%
p-value: p=0.019
Irbesartan, but not fosinopril, significantly lowers erythropoietin and hemoglobin levels in essential hypertensive patients with normal renal function.
Irbesartan may modestly lower erythropoietin and hemoglobin; leaves open differential hematologic effects versus ACE inhibitors in renal disease.
OBJECTIVE: To compare the response of erythropoiesis to an angiotensin receptor blocker, irbesartan with an angiotensin conversing enzyme inhibitor, fosinopril, in essential hypertensive patients with normal renal function. DESIGN AND METHODS: Thirty patients were randomized to receive either irbesartan (150 mg once daily) (n = 15, mean age 65.2+/-8.7 years) or fosinopril (20 mg once daily) (n = 15, mean age 57.4+/-11.5 years, difference is not significant) during 12 weeks. Plasma erythropoietin, hemoglobin (Hb) and hematocrit (Hc) levels were measured at start and monthly after receiving the treatment. All values are expressed as mean+/-1SD. RESULTS: Irbesartan decreased erythropoietin levels (baseline 20.7+/-1.3 vs. 18.1+/-3.7 mU/mL, p=0.019), but they remained unchanged with fosinopril (baseline 18.8+/-1.3 vs. 18.6+/-1.6 mU/mL). Hb levels lowered in irbesartan group (baseline 13.8+/-1.2 vs. 13.5+/-1.1 g/dL, p=0.029), but they did not change in fosinopril-treated patients (baseline 14.6+/-1.3 vs. 14.5+/-1.3 g/dL). Hc did not show any change neither in irbesartan group (baseline 40.9+/-3.7 vs. 40.8+/-3.3 %) nor in fosinopril group (baseline 14.6+/-1.3 vs. 14.5+/-1.3 %). CONCLUSIONS: Irbesartan lowered erythropoietin secretion and hemoglobin levels in essential hypertensives. Fosinopril can neither influence erythropoietin secretion nor decrease hemoglobin levels. Angiotensin receptor blockers seem to get higher efficacy for antagonism angiotensin effects. Safety of angiotensin receptor blockers in anemic hypertensive patients should be studied.
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Robles et al. (2004) conducted an RCT in Essential hypertension (n=30). Irbesartan vs. Fosinopril was evaluated on Plasma erythropoietin levels at 12 weeks (mU/mL) (p=0.019). Irbesartan significantly decreased erythropoietin levels (from 20.7 to 18.1 mU/mL, p=0.019) and hemoglobin levels in essential hypertensives, whereas fosinopril had no effect.
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