IBD: Angiotensin II Blockade Worsens Outcomes

Treatment with angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in patients with IBD is associated with more hospitalizations, operations, and corticosteroid use.

Activation of the renin-angiotensin system (RAS) is believed to contribute to inflammatory bowel disease. Inhibiting RAS by using angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers protects against inflammatory bowel disease (IBD) in animal studies.

But ACEI or ARB use in IBD patients did not help. In fact, it was associated with more hospitalizations, operations, and corticosteroid use, a University of Chicago research team reported at the American College of Gastroenterologist Annual Scientific meeting in Honolulu Oct. 16 through Oct. 21.

Jeffrey Jacobs, MD, and colleagues said they did a retrospective study in which they looked at a cohort of patients, 65 of whom had received ACEI or ARB, and at how they did for the following six-month period or longer compared with a control group. The treatment group included 41 patients with Crohn's disease and 24 with ulcerative colitis.

The controls, a group of 260 IBD patients, did not receive ACEI or ARB.

The Crohn's patients taking ACEI or ARB had a rate of hospitalizations twice as high as controls. The ulcerative colitis patients taking ACEI or ARB had a hospitalization rate three times higher than controls, a rate of needing surgery that was twice as high and both groups of treated patients were more likely to need steroids.

The researchers concluded "ACEI or ARB use in IBD patients was associated with more hospitalizations, operations, and corticosteroid use in our tertiary referral population." They recommended new prospective studies "to assess the causal role of RAS inhibition on disease activity."