Renin-angiotensin system (RAS) blockade by angiotensin-converting enzyme
inhibitors (ACEis) or angiotensin-receptor blockers (ARBs) has been
related to anemia in various situations. We aimed to investigate whether
discontinuation of RAS inhibitors improves erythropoiesis in patients
with lower-risk myelodysplastic syndromes (LR-MDSs). Seventy-four
patients with LR-MDS were divided into three groups matched for gender
and age. Group A consisted of 20 hypertensive patients who discontinued
RAS inhibitors and received alternative medications. Group B consisted
of 26 patients who continued to receive ACEi/ARB and Group C included 28
patients (50% hypertensive) never exposed to ACEi/ARB. Half of the
patients in each group were under treatment with recombinant human
erythropoietin (rHuEPO). Data were collected at baseline and after 3, 6
and 12 months. Group A showed a significant increase in hemoglobin from
10.4 +/- 1g/dL at baseline to 12.6 +/- 1.2 g/dL after 12 months (p =
0.035) and in hematocrit (31.4 +/- 3% versus 37.9 +/- 4%, p = 0.002).
Incident anemia decreased from 100% at baseline to 60% at 12 months (p
= 0.043) despite a concomitant dose reduction in rHuEPO by 18% (p =
0.035). No changes in hemoglobin and hematocrit were observed in both
Group B and Group C. In the subset of patients not treated with rHuEPO,
improvement of erythropoiesis was found only in Group A, as measured by
changes in hemoglobin (11.5 +/- 1 g/dL versus 12.4 +/- 1.3 g/dL, p =
0.041) and hematocrit (34.5 +/- 3% versus 37.1 +/- 4%, p = 0.038)
after 12 months. In contrast, Group B and Group C decreased hemoglobin
and hematocrit after 12 months (p < 0.05). In conclusion,
discontinuation of ACEi/ARB in LR-MDS patients is followed by a
significant recovery of erythropoiesis after 12 months
