@article{3099003,
    title = "Prevalence and prognostic significance of anemia in patients with
congestive heart failure treated with standard vs high doses of
enalapril",
    author = "Terrovitis, JV and Anastasiou-Nana, MI and Alexopoulos, GP and Tsolakis, and EJ and Margari, ZJ and Drakos, SG and Tsagalou, EP and Papazoglou, P and and Efentakis, S and Nanas, JN",
    journal = "The Journal of Heart and Lung Transplantation",
    year = "2006",
    volume = "25",
    number = "3",
    pages = "333-338",
    publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",
    issn = "1053-2498",
    doi = "10.1016/j.healun.2005.09.019",
    abstract = "Background: Anemia is common in patients with congestive heart failure
(CHF), although its etiology and pathophysiology remain largely
unexplained. The purpose of this study was to examine the prognostic
significance of a low hematocrit (Hct) in patients with CHF and the
possible role of angiotensin-converting enzyme inhibition in anemia
development.
Methods: Hct was measured at the time of enrollment of 160 patients with
CHF, mean age 56 12 years, in New York Heart Association (NYHA)
functional class 2.6 +/- 0.7 and with left ventricular ejection fraction
of 20 +/- 9%. They were randomized to standard (mean: 17.9 +/- 4.3
mg/day) or high (mean: 42 +/- 19.3 mg/day) doses of enalapril. The
follow-up duration was 2 years. Cox regression models were used to
identify prognostic factors, and correlations among individual variables
were tested.
Results: Mean baseline Hct was 42.7 +/- 5%. In multivariate analyses,
low Hct (p = 0.036), older age (p = 0.022) and low systolic blood
pressure (p = 0.032) were independent predictors of death within 2
years. A correlation was found between baseline Hct and NYHA class
(Spearman’s correlation coefficient: -0.183, p = 0.008). A significant
decrease in Hct from 43.2 +/- 4.9% at baseline to 40.7 +/- 4.4% at 2
years was observed in the group treated with high doses of enalapril (p
< 0.001).
Conclusions: Low baseline Hct predicted poor 2-year prognosis in
patients with CHF. Enalapril administered in high doses increased the
incidence of anemia in this population. The underlying pathophysiologic
mechanism and effects of maintaining a normal Hct on clinical outcomes
remain to be determined."
}