Use of Angiotensin Receptor Blockers in Celiac Disease Associated with Worse Outcomes.

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.