Systematic review with meta-analysis: the association between the use of calcium channel blockers and

Related Experiment Video

Updated: Aug 10, 2026

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
07:10

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy

Published on: June 18, 2020

23.5K

Y He1, E W Chan1, W K Leung2

  • 1Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong.

Alimentary Pharmacology & Therapeutics
|April 23, 2015
PubMed

Insights

Calcium channel blockers (CCBs) may have a slight association with gastrointestinal bleeding (GIB). However, this link is not clinically significant when confounding factors are considered.

Area of Science:

  • Cardiovascular Pharmacology
  • Gastroenterology
  • Clinical Epidemiology

Background:

  • Calcium channel blockers (CCBs) possess potential anti-platelet effects, leading to a suggested association with gastrointestinal bleeding (GIB).
  • Previous research on the CCB-GIB link has yielded conflicting results, necessitating further investigation.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) and observational studies.
  • To clarify the association between CCB use and the risk of GIB.

Main Methods:

  • A comprehensive systematic search of major databases (PubMed, EMBASE, Cochrane, Trial Register) was performed up to January 2015.
  • Included studies evaluated CCB exposure and reported GIB outcomes.
  • The inverse variance method with a random effects model was employed for pooled estimate calculations.

Main Results:

  • Seventeen studies (4 RCTs, 11 case-control, 2 cohort) were meta-analyzed.
  • Overall, CCB use showed a marginal risk ratio (RR) of 1.17 (95% CI 1.01-1.36) for GIB.
  • Subgroup analysis indicated a higher risk of lower GIB (RR=1.83) but not upper GIB; however, RCT data (RR=0.93) did not support an association. The increased risk was primarily seen in studies not adjusting for GIB history or anti-ulcer drug use.

Conclusions:

  • A marginal association exists between CCB use and GIB risk.
  • This association lacks significant clinical relevance due to confounding factors and comparator effects.
  • Adjusting for confounders like prior GIB history or anti-ulcer drug use rendered the association nonsignificant.
Abstract

Related Concept Videos

Antihypertensive Drugs: Action of Calcium Channel Blockers01:18

Antihypertensive Drugs: Action of Calcium Channel Blockers

Calcium ions are essential to contract smooth muscle cells in blood vessels. They enter these cells through voltage-dependent calcium channels, specifically L-type calcium channels in the cell membrane. These L-type calcium channels are integral to the excitation-contraction coupling process in smooth muscle. When a stimulus is received by smooth muscle cells, their membrane depolarizes. This alteration in membrane potential instigates the opening of L-type calcium channels. As a result,...
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers01:22

Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers

Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers01:20

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
Antianginal Drugs: Calcium Channel Blockers and Ranolazine01:25

Antianginal Drugs: Calcium Channel Blockers and Ranolazine

Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT01:25

Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT

Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...