Retrospective Analysis of Anemia Risk in Heart Failure with a Preserved Ejection Fraction: A Comparison of ACE Inhibitors and ARBs

Heart failure, which is characterized by structural or functional abnormalities that result in symptoms such as dyspnea, fatigue, and edema, significantly affects mortality rates and healthcare expenditures. Anemia, which affects approximately 60％ of patients with chronic heart failure, intensifies the prognosis because of reduced oxygen delivery. This study examined the impact of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) on anemia in patients with heart failure and preserved ejection fraction (HFpEF). The study included inpatients aged >18 years who were diagnosed with HFpEF and treated with either ACE-Is or ARBs. The exclusion criteria were patients receiving concurrent ACE-I and ARB therapy, those with severe anemia (hemoglobin <8.0 g/dL), a history of gastrointestinal bleeding, or treatment with erythropoiesis-stimulating agents. The cumulative incidence of severe anemia (hemoglobin <8.0 g/dL) was significantly higher in patients treated with ACE-Is than in those treated with ARBs (P = 0.04). Despite their comparable efficacy in treating heart failure, ACE-Is may pose a greater risk of anemia, suggesting that ARBs may be a more suitable option for mitigating anemia in patients with HFpEF. This study emphasizes the importance of monitoring hemoglobin levels in patients with HFpEF undergoing treatment with ACE-Is. Additional large-scale prospective studies are required to validate these findings and to elucidate the underlying mechanisms.