NEW research presented at the American College of Gastroenterology (ACG) Annual Scientific Meeting suggests that angiotensin receptor blockers (ARBs), a class of drugs commonly used to manage hypertension, may be associated with poorer outcomes in patients with coeliac disease. Findings indicated that patients taking ARBs had a higher likelihood of experiencing persistent symptoms and markers of poor small bowel healing, such as anaemia and iron deficiency.
Isabel A Hujoel, University of Washington, USA, explained that given the known potential of ARBs to cause enteropathy resembling coeliac disease, the aim of the study was to explore whether ARBs could exacerbate the underlying disease and contribute to persistent symptoms.
To investigate, Hujoel and her team analysed 1,849 patients with coeliac disease from the ‘All of Us’ biomedical database (median age: 49.8 years, 79% female). Patients were grouped into three categories: those with coeliac disease who were not prescribed ARBs (n=1,587), those prescribed ARBs before their coeliac diagnosis (n=120), and those prescribed ARBs after diagnosis (n=142).
The study found that patients with coeliac disease on ARBs had a higher risk of anaemia, iron deficiency, abdominal pain, and diarrhoea compared to those not on ARBs. However, ARB use did not significantly increase risks for weight loss or vitamin deficiencies. For example, patients on ARBs showed increased risk for low haemoglobin (HR=1.86; 95% CI: 1.48–2.33 for all patients on ARBs, and HR=1.98; 95% CI: 1.35–2.92 for those prescribed ARBs after diagnosis). Similarly, ARB use was associated with higher risks for iron deficiency (HR=1.7; 95% CI: 1.28–2.26 for all ARB users, and HR=1.72; 95% CI: 1.07–2.75 for those prescribed after diagnosis).
Hujoel noted that these findings imply a potential for ARBs to worsen coeliac outcomes, urging caution for clinicians prescribing ARBs to coeliac patients. Further research, ideally a randomised double-blind study, is needed to validate these observations and assess mucosal healing outcomes directly.
Reference
Hujoel IA et al. The safety of angiotensin receptor blockers in celiac disease. ACG Annual Scientific Meeting,25-30 October, 2024.
