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Use of Angiotensin Receptor Blockers in Celiac Disease Associated with Worse Outcomes
Isabel A Hujoel1,2, Margaux L A Hujoel3,4
1Division of Gastroenterology, University of Washington, Seattle, WA, USA. isabelh@uw.edu.
Insights
Angiotensin receptor blockers may worsen symptoms and malabsorption in celiac disease patients. Further research is needed to understand this potential interaction and its clinical implications.
Area of Science:
- Gastroenterology
- Pharmacology
- Internal Medicine
Background:
- Celiac disease and angiotensin receptor blocker-associated enteropathy share similar pathophysiology.
- Limited research exists on the safety of angiotensin receptor blockers (ARBs) in celiac disease patients.
- A prior single-center study suggested potential negative outcomes with ARB use in celiac disease.
Purpose of the Study:
- To investigate the association between ARB prescription and adverse outcomes in a large cohort of celiac disease patients.
- To utilize a national database for a comprehensive analysis of ARB safety in this population.
Main Methods:
- Analysis of the All of Us Research Program database.
- Identification of celiac disease using SNOMED terms.
- Extraction of ARB prescription data and relevant clinical outcomes (symptoms, malabsorption markers).
- Survival analysis to determine the association between ARB use and outcomes.
Main Results:
- 1849 individuals with celiac disease were analyzed; 262 were prescribed ARBs.
- ARB prescription was significantly associated with increased hazard for low hemoglobin, iron deficiency, abdominal pain, and diarrhea.
- The association between ARBs and low hemoglobin persisted after adjusting for diagnosis timing and comorbidities.
Conclusions:
- ARB use in celiac disease is linked to persistent symptoms and markers of malabsorption.
- Further investigation is required to elucidate potential underlying interactions between ARBs and celiac disease.
- The findings highlight the need for careful consideration of ARB prescriptions in patients with celiac disease.
Background:
Angiotensin receptor blocker-associated enteropathy and celiac disease share similarities, including pathophysiology. Only one single-center study has examined the safety of these medications in celiac disease, and found that they may lead to worse outcomes.
Aims:
We aimed to address this question using a larger cohort from a national database.
Methods:
We analyzed the All of Us Research Program database and identified celiac disease using SNOMED terms. Prescription data identified angiotensin receptor blocker prescriptions. Outcomes of interest included symptoms (abdominal pain, diarrhea, weight loss) and surrogate markers of malabsorption (iron deficiency, vitamin deficiency, low hemoglobin). Survival analysis was performed to determine the association between angiotensin receptor blocker prescription and outcomes of interest in those with celiac disease.
Results:
1849 individuals with celiac disease (1460 females, 389 males) were identified. Of those with celiac disease, 262 were prescribed an angiotensin receptor blocker. Those with celiac disease had significantly greater hazard for low hemoglobin (p = 5.9 × 10-7), iron deficiency (p = 0.0003), abdominal pain (p = 0.0006), and diarrhea (p = 0.002) after angiotensin receptor blocker prescription. The association with low hemoglobin remains when restricting to individuals prescribed an angiotensin receptor blocker after celiac disease diagnosis (p = 0.0065), and when controlling for comorbidities. In sensitivity analysis, two other antihypertensive classes were also associated with low hemoglobin in those with celiac disease.
Conclusions:
Prescription of angiotensin receptor blockers in celiac disease is associated with persistent symptoms and surrogate markers of malabsorption. Further research is needed to determine if this reflects an underlying interaction between the indication for these medications and celiac disease.
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