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The Decrement of Hemoglobin Concentration with Angiotensin II Receptor Blocker Treatment Is Correlated with the Reduction of Albuminuria in Non-Diabetic Hypertensive Patients: Post-Hoc Analysis of ESPECIAL Trial.

An JN, Hwang JH, Lee JP, Chin HJ, Kim S, Kim DK, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Lim CS - PLoS ONE (2015)

Bottom Line: After the 8-week treatment with an ARB, Hb and EPO levels significantly decreased.Patients with a greater decrease in Hb exhibited a greater reduction in 24-hour urinary albumin excretion compared with patients with less of a decrease or no decrease in Hb, whereas no associations with a decline in renal function and EPO levels were noted.Decreased Hb concentrations following ARB treatment were positively correlated with reduced albuminuria in non-diabetic hypertensive patients, regardless of decreased blood pressure and EPO levels or renal function decline.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Blockade of the renin-angiotensin-aldosterone system exhibits a renoprotective effect; however, blockade of this system may also decrease hemoglobin (Hb) and erythropoietin (EPO) levels. We evaluated the correlation between reduced albuminuria and decreased hemoglobin concentrations after treatment with an angiotensin II receptor blocker (ARB). Two hundred forty-five non-diabetic hypertensive participants with established albuminuria and relatively preserved renal function were treated with an ARB (40 mg/day olmesartan) for eight weeks. Subsequent changes in various clinical parameters, including Hb, EPO, and albuminuria, were analyzed following treatment. After the 8-week treatment with an ARB, Hb and EPO levels significantly decreased. Patients with a greater decrease in Hb exhibited a greater reduction in 24-hour urinary albumin excretion compared with patients with less of a decrease or no decrease in Hb, whereas no associations with a decline in renal function and EPO levels were noted. Multivariate logistic regression analysis demonstrated a correlation between the reduction of urine albumin excretion and the decrease in Hb levels (after natural logarithm transformation, adjusted odds ratio 1.76, 95% confidence interval 1.21-2.56, P = 0.003). Linear regression analysis also supported this positive correlation (Pearson correlation analysis; R = 0.24, P < 0.001). Decreased Hb concentrations following ARB treatment were positively correlated with reduced albuminuria in non-diabetic hypertensive patients, regardless of decreased blood pressure and EPO levels or renal function decline.

No MeSH data available.


Related in: MedlinePlus

Correlation between the decrease in hemoglobin level and the decline in eGFR levels.A. Changes in eGFR levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.627). GFR, glomerular filtration rate. B. Correlation between the decrease in hemoglobin level and the decline in EPO levels. Changes in EPO levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.378). EPO, erythropoietin.
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pone.0128632.g001: Correlation between the decrease in hemoglobin level and the decline in eGFR levels.A. Changes in eGFR levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.627). GFR, glomerular filtration rate. B. Correlation between the decrease in hemoglobin level and the decline in EPO levels. Changes in EPO levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.378). EPO, erythropoietin.

Mentions: To examine various clinical parameters associated with changes in Hb levels, all patients were classified into two groups based on the mean decrease in Hb levels during the 8-week ARB treatment. In the group that exhibited a greater decrease in Hb levels, increased numbers of current smokers and individuals with a history of taking aspirin and statins were noted (Table 2). Parameters measured at week 0 were not related to the decrease in Hb levels, with the exception of serum cholesterol levels. Patients in the group with a greater decrease exhibited lower BP and EPO levels at week 8 and a greater reduction in systolic BP between weeks 0 and 8 compared with the group with less of a decrease (Table 3). In addition, a greater reduction in 24-hour urinary albumin excretion was significantly associated with a greater decrease in Hb levels. By contrast, no associations were noted among decreased Hb levels and the extent of decline in eGFR, Ccr, and EPO levels. These findings were also verified by linear regression analyses (Fig 1A and 1B).


The Decrement of Hemoglobin Concentration with Angiotensin II Receptor Blocker Treatment Is Correlated with the Reduction of Albuminuria in Non-Diabetic Hypertensive Patients: Post-Hoc Analysis of ESPECIAL Trial.

An JN, Hwang JH, Lee JP, Chin HJ, Kim S, Kim DK, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Lim CS - PLoS ONE (2015)

Correlation between the decrease in hemoglobin level and the decline in eGFR levels.A. Changes in eGFR levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.627). GFR, glomerular filtration rate. B. Correlation between the decrease in hemoglobin level and the decline in EPO levels. Changes in EPO levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.378). EPO, erythropoietin.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476682&req=5

pone.0128632.g001: Correlation between the decrease in hemoglobin level and the decline in eGFR levels.A. Changes in eGFR levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.627). GFR, glomerular filtration rate. B. Correlation between the decrease in hemoglobin level and the decline in EPO levels. Changes in EPO levels following angiotensin receptor blocker treatment do not correlate with decreased hemoglobin levels (P = 0.378). EPO, erythropoietin.
Mentions: To examine various clinical parameters associated with changes in Hb levels, all patients were classified into two groups based on the mean decrease in Hb levels during the 8-week ARB treatment. In the group that exhibited a greater decrease in Hb levels, increased numbers of current smokers and individuals with a history of taking aspirin and statins were noted (Table 2). Parameters measured at week 0 were not related to the decrease in Hb levels, with the exception of serum cholesterol levels. Patients in the group with a greater decrease exhibited lower BP and EPO levels at week 8 and a greater reduction in systolic BP between weeks 0 and 8 compared with the group with less of a decrease (Table 3). In addition, a greater reduction in 24-hour urinary albumin excretion was significantly associated with a greater decrease in Hb levels. By contrast, no associations were noted among decreased Hb levels and the extent of decline in eGFR, Ccr, and EPO levels. These findings were also verified by linear regression analyses (Fig 1A and 1B).

Bottom Line: After the 8-week treatment with an ARB, Hb and EPO levels significantly decreased.Patients with a greater decrease in Hb exhibited a greater reduction in 24-hour urinary albumin excretion compared with patients with less of a decrease or no decrease in Hb, whereas no associations with a decline in renal function and EPO levels were noted.Decreased Hb concentrations following ARB treatment were positively correlated with reduced albuminuria in non-diabetic hypertensive patients, regardless of decreased blood pressure and EPO levels or renal function decline.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Blockade of the renin-angiotensin-aldosterone system exhibits a renoprotective effect; however, blockade of this system may also decrease hemoglobin (Hb) and erythropoietin (EPO) levels. We evaluated the correlation between reduced albuminuria and decreased hemoglobin concentrations after treatment with an angiotensin II receptor blocker (ARB). Two hundred forty-five non-diabetic hypertensive participants with established albuminuria and relatively preserved renal function were treated with an ARB (40 mg/day olmesartan) for eight weeks. Subsequent changes in various clinical parameters, including Hb, EPO, and albuminuria, were analyzed following treatment. After the 8-week treatment with an ARB, Hb and EPO levels significantly decreased. Patients with a greater decrease in Hb exhibited a greater reduction in 24-hour urinary albumin excretion compared with patients with less of a decrease or no decrease in Hb, whereas no associations with a decline in renal function and EPO levels were noted. Multivariate logistic regression analysis demonstrated a correlation between the reduction of urine albumin excretion and the decrease in Hb levels (after natural logarithm transformation, adjusted odds ratio 1.76, 95% confidence interval 1.21-2.56, P = 0.003). Linear regression analysis also supported this positive correlation (Pearson correlation analysis; R = 0.24, P < 0.001). Decreased Hb concentrations following ARB treatment were positively correlated with reduced albuminuria in non-diabetic hypertensive patients, regardless of decreased blood pressure and EPO levels or renal function decline.

No MeSH data available.


Related in: MedlinePlus