Abstract
Several clinical and experimental observations suggest that an intact and activated renin-angiotensin system (RAS) may be an important determinant of erythropoiesis in a variety of clinical conditions, including hypertension, chronic renal insufficiency or failure, chronic obstructive pulmonary disease, and congestive heart failure. Accordingly, RAS inactivation may confer susceptibility to the hematocrit-lowering effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Indeed, a dose-dependent decrease in hematocrit is observed within the first month of such therapy. In the majority of patients with hypertension decreases in hematocrit values after RAS inactivation are small and not clinically important. In extreme conditions, however, such as erythrocytosis after successful renal transplantation, secondary polycythemia of chronically hypoxemic COPD patients, erythrocytosis associated with renovascular hypertension, severe cardiac or renal failure, the hematocrit-lowering effect of angiotensing-converting enzyme inhibitors and angiotensin receptor blocker may be profound and even lead to or worsen anemia. Hematocrit reachs its nadir value within three months, and then it remains stable during long-term observations. After discontinuation of RAS blockade, hematocrit values rise gradually over the next three to four months towards the pretreatment levels. The mechanism(s) related to this phenomenon is not yet fully understood, but angiotensin II seems to be responsible for inappropriately sustaining secretion of erythropoietin despite hematocrit elevation and capable to directly stimulate the erythroid progenitors in bone marrow to produce erythrocytes.
Keywords: Hematocrit-lowering Effect, erythrocytes, erythropoietin, Renin-Angiotensin
Current Topics in Medicinal Chemistry
Title: Hematocrit-lowering Effect Following Inactivation of Renin-Angiotensin System with Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Volume: 4 Issue: 4
Author(s): K. P. Marathias, B. Agroyannis, T. Mavromoustakos, J. Matsoukas and D. V. Vlahakos
Affiliation:
Keywords: Hematocrit-lowering Effect, erythrocytes, erythropoietin, Renin-Angiotensin
Abstract: Several clinical and experimental observations suggest that an intact and activated renin-angiotensin system (RAS) may be an important determinant of erythropoiesis in a variety of clinical conditions, including hypertension, chronic renal insufficiency or failure, chronic obstructive pulmonary disease, and congestive heart failure. Accordingly, RAS inactivation may confer susceptibility to the hematocrit-lowering effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Indeed, a dose-dependent decrease in hematocrit is observed within the first month of such therapy. In the majority of patients with hypertension decreases in hematocrit values after RAS inactivation are small and not clinically important. In extreme conditions, however, such as erythrocytosis after successful renal transplantation, secondary polycythemia of chronically hypoxemic COPD patients, erythrocytosis associated with renovascular hypertension, severe cardiac or renal failure, the hematocrit-lowering effect of angiotensing-converting enzyme inhibitors and angiotensin receptor blocker may be profound and even lead to or worsen anemia. Hematocrit reachs its nadir value within three months, and then it remains stable during long-term observations. After discontinuation of RAS blockade, hematocrit values rise gradually over the next three to four months towards the pretreatment levels. The mechanism(s) related to this phenomenon is not yet fully understood, but angiotensin II seems to be responsible for inappropriately sustaining secretion of erythropoietin despite hematocrit elevation and capable to directly stimulate the erythroid progenitors in bone marrow to produce erythrocytes.
Export Options
About this article
Cite this article as:
Marathias P. K., Agroyannis B., Mavromoustakos T., Matsoukas J. and Vlahakos V. D., Hematocrit-lowering Effect Following Inactivation of Renin-Angiotensin System with Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers, Current Topics in Medicinal Chemistry 2004; 4 (4) . https://dx.doi.org/10.2174/1568026043451311
DOI https://dx.doi.org/10.2174/1568026043451311 |
Print ISSN 1568-0266 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4294 |
Call for Papers in Thematic Issues
Chemistry Based on Natural Products for Therapeutic Purposes
The development of new pharmaceuticals for a wide range of medical conditions has long relied on the identification of promising natural products (NPs). There are over sixty percent of cancer, infectious illness, and CNS disease medications that include an NP pharmacophore, according to the Food and Drug Administration. Since NP ...read more
Current Trends in Drug Discovery Based on Artificial Intelligence and Computer-Aided Drug Design
Drug development discovery has faced several challenges over the years. In fact, the evolution of classical approaches to modern methods using computational methods, or Computer-Aided Drug Design (CADD), has shown promising and essential results in any drug discovery campaign. Among these methods, molecular docking is one of the most notable ...read more
Drug Discovery in the Age of Artificial Intelligence
In the age of artificial intelligence (AI), we have witnessed a significant boom in AI techniques for drug discovery. AI techniques are increasingly integrated and accelerating the drug discovery process. These developments have not only attracted the attention of academia and industry but also raised important questions regarding the selection ...read more
From Biodiversity to Chemical Diversity: Focus of Flavonoids
Flavonoids are the largest group of polyphenols, plant secondary metabolites arising from the essential aromatic amino acid phenylalanine (or more rarely from tyrosine) via the phenylpropanoid pathway. The flavan nucleus is the basic 15-carbon skeleton of flavonoids (C6-C3-C6), which consists of two phenyl rings (A and B) and a heterocyclic ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
The Tree of Sirtuins and the Garden of Cardiovascular Youth
Current Vascular Pharmacology The Brain, the Penis and Steroid Hormones: Clinical Correlates with Endothelial Dysfunction
Current Pharmaceutical Design Protein Kinase C Isozymes: Memory Therapeutic Potential
Current Drug Targets - CNS & Neurological Disorders Mevalonate Pathway and Human Cancers
Current Molecular Pharmacology An Up-date of Olive Oil Phenols in Inflammation and Cancer: Molecular Mechanisms and Clinical Implications
Current Medicinal Chemistry Effect of Oral Alkali Supplementation on Progression of Chronic Kidney Disease
Current Hypertension Reviews Future Therapeutic Strategies in Inflammatory Cardiomyopathy: Insights from the Experimental Autoimmune Myocarditis Model
Cardiovascular & Hematological Disorders-Drug Targets Does A Subclinical Cardiotoxic Effect of Clozapine Exist? Results from a Follow-up Pilot Study
Cardiovascular & Hematological Agents in Medicinal Chemistry Redox Homeostasis and Epigenetics in Non-alcoholic Fatty Liver Disease (NAFLD)
Current Pharmaceutical Design Mini Heme-Proteins: Designability of Structure and Diversity of Functions
Current Protein & Peptide Science Proteomics Analysis Revealed an Altered Left Ventricle Protein Profile in a Mouse Model of Transverse Aortic Constriction
Protein & Peptide Letters Erythropoietin and mTOR: A “One-Two Punch” for Aging-Related Disorders Accompanied by Enhanced Life Expectancy
Current Neurovascular Research Skeletal Muscle in Motor Neuron Diseases: Therapeutic Target and Delivery Route for Potential Treatments
Current Drug Targets Appraisal of Saxagliptin as Treatment of Type 2 Diabetes
Current Drug Therapy Endothelial Dysfunction in Morbid Obesity
Current Pharmaceutical Design Inflammatory Biomarkers Predicting Events in Atherosclerosis
Current Medicinal Chemistry Ca<sup>2+</sup>/Calmodulin-Dependent Protein Kinase- II in Vasoactive Peptide- Induced Responses and Vascular Biology
Current Vascular Pharmacology Gene Therapy Strategies Towards Immune Tolerance to Treat the Autoimmune Diseases
Current Gene Therapy Alzheimers Disease and n-3 Polyunsaturated Fatty Acids: Beneficial Effects and Possible Molecular Pathways Involved
Current Signal Transduction Therapy Resveratrol, a Phytochemical Inducer of Multiple Cell Death Pathways: Apoptosis, Autophagy and Mitotic Catastrophe
Current Medicinal Chemistry