The Effect Of Lisinopril On Polycythemia

Demonstrating that ACE inhibitor therapy with lisinopril lowers hemoglobin, hematocrit, and erythropoietin levels could introduce a novel therapeutic approach for the management of secondary polycythemia due to high-oxygen-affinity hemoglobin variants, oxygen-sensing pathway mutations, or other unexplained and potentially irreversible forms of erythrocytosis, potentially reducing reliance on repeated phlebotomies and lowering thrombotic risk.

Inclusion criteria

• Hemoglobin in Men: >16.5 g/dL (10.3 mmol/L).
• Hemoglobin in Women >16.0 g/dL (10.0 mmol/L).
• BMI 18-40 kg/m2.

Exclusion criteria

• Positive JAK2 gene linked to Polycythemia Vera.
• Current smoker or previous heavy smoker (>15 pack years) who quit less than 12 months prior to enrollment.
• Resting SpO₂ ≤ 94% on room air.
• Current or recent (within the past 6 months) use of testosterone or androgen supplementation.
• Any confounding respiratory or renal disease, including diagnosed or suspected sleep apnea, or stage 3 and up of chronic kidney disease.
• Any confounding hematologic disease that may alter hemoglobin level.
• Currently treated with ACE inhibitors.
• Currently treated with potassium-sparing diuretics.
• Currently on SGLT2 or use within 4 weeks prior to screening.
• Baseline systolic blood pressure ≤90 mmHg.
• Baseline systolic blood pressure >160 mmHg or diastolic blood pressure >100 mmHg.
• Occupational exposure associated with chronically elevated COHb (auto repair, etc.).
• History of anaphylaxis or angioedema.
• Pregnant or breastfeeding.