Impact of Angiotensin-Converting Enzyme Inhibitors on Disease Symptoms in Patients with Chronic Myeloproliferative...

Patients with chronic myeloproliferative neoplasms (MPNs) have upregulated renin-angiotensin-aldosteron system in the bone marrow and suffer from debilitating inflammation-linked symptoms. The use of angiotensin-converting enzyme inhibitors (ACEi) has been shown to improve hematocrit control and thrombotic risk in MPNs. Here, we investigated whether ACEi use may also have an impact on disease-related symptoms in MPNs.

This cross-sectional two-center study included 100 consecutive MPN patients who fulfilled the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) at the time of study entry.

The use of ACEi correlated with older age, presence of JAK2 mutation, prior thrombosis and different cardiovascular risk factors. Patients using ACEi also presented with higher total symptom score (p = 0.002), more abdominal discomfort (p = 0.031), concentration problems (p = 0.050) and bone pains (p = 0.001). To account for baseline variables that may have potentially impacted MPN symptom control, ACEi users and non-users were case-matched in a 1:1 ratio with respect to sex, age, cytoreductive treatment, and cardiovascular risk factors. Again, there were no differences in almost all MPN-SAF items with respect to ACEi use (p > 0.050 for all analyses).

The use of ACEi does not seem to mitigate disease-related symptoms in MPNs. Prospective randomized trials are needed to fully elucidate their therapeutic potential in MPNs.