| アブストラクト | AIMS: To determine whether initiation of treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARBs) is associated with a subsequent reduction in haemoglobin in the general population. METHODS: We undertook a national cohort study over a thirteen-year period (2004 to 2016), using routine primary healthcare data from the United Kingdom Clinical Practice Research Datalink. We compared ACEI/ARB initiation with calcium channel blocker (CCB) initiation, to minimise confounding by indication. We included all first ACEI/ARB or CCB prescriptions in adults with at least one haemoglobin result in the 12 months before and six months after drug initiation. Our primary outcome was a >/=1g/dL haemoglobin reduction in the six months after drug initiation. RESULTS: We examined 146,610 drug initiation events in 136,655 patients. Haemoglobin fell by >/=1g/dL after drug initiation in 19.5% (16,936/86,652) of ACEI/ARB initiators and 15.9% (9,521/59,958) of CCB initiators. The adjusted odds ratio of a >/=1g/dL haemoglobin reduction in ACEI/ARB initiators vs. CCB initiators was 1.15 (95%CI 1.12-1.19). CONCLUSIONS: ACEI/ARBs are associated with a modest increase in the risk of a haemoglobin reduction. For every 100 patients in our study that initiated a CCB, 16 experienced a >/=1g/dL haemoglobin decline. If the effect is causal, three additional patients would have experienced this outcome if they had received an ACEI/ARB. This may have implications for drug choice and monitoring for many patients in primary care. Further research could identify patients at higher risk of this outcome, who may benefit from closer monitoring. |
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| ジャーナル名 | British journal of clinical pharmacology |
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| 投稿日 | 2020/6/13 |
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| 投稿者 | Greenhall, George H B; Mansfield, Kathryn E; Nitsch, Dorothea; Iwagami, Masao; Leyrat, Clemence; Johnston, Rosalynd; Smeeth, Liam; Tomlinson, Laurie A |
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| 組織名 | Department of Non-Communicable Disease Epidemiology, London School of Hygiene and;Tropical Medicine, London, UK.;Department of Health Services Research, Faculty of Medicine, University of;Tsukuba, Ibaraki, Japan.;Department of Haematology, Brighton and Sussex Universities Hospital NHS Trust,;Brighton, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32530524/ |
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