Serum erythropoietin in heart failure patients treated with ACE-inhibitors or AT1 antagonists

Background: Erythropoietin (Epo), a growth factor produced by the kidney, is important in heart failure patients to promote oxygen delivery to tissues. Seventy-two chronic heart failure (CHF) patients at our outpatient clinic were subjected to morning serum Epo-level measurements and classified according to NYHA criteria. Results: Forty-eight patients of classes III and IV had a significantly elevated serum Epo-level of 42.9 +/- 40.3 mIU/ml (mean +/- 1 S.D.) when compared to the mean level of 24 patients of classes I and II who had a normal range mean value of 13.4 +/- 6.2 mIU/ml (P < 0.05). Patients on angiotensin-converting enzyme (ACE) inhibitors showed a trend towards lower serum Epo-levels compared to patients treated with angiotensin-II type-1 receptor antagonists (AT(1) antagonists) (levels: 33.3 +/- 35.6 mIU/ml and 43.6 +/- 38.1 mIU/ml). This trend did not, however, reach statistical significance (P = 0.36). Conclusion: We suggest that a desirable Epo increase in class III and IV CHF patients could be achieved by either recombinant human Epo administration or, possibly, by appropriate selection of the concomitant medical therapy. A large prospective study shall investigate the possible advantage of AT(1) antagonists over ACE-inhibitors with regard to Epo effect. (C) European Society of Cardiology. All rights reserved.