Risk of Variceal Hemorrhage in Patients With Cirrhosis Taking Calcium-Channel Blockers

Calcium-channel blockers (CCBs) are widely prescribed for arterial hypertension. However, it remains uncertain whether CCBs, through their vasodilatory effects, influence the risk of variceal hemorrhage (VH) in cirrhosis patients. This study aimed to investigate the association between CCB use and VH risk in cirrhosis patients.

This territory-wide retrospective cohort study included patients with cirrhosis and no prior history of VH identified from the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong between 2000 and 2023. An active comparator new-user design was adopted, with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) as active comparators. Either CCB or ACE inhibitor/ARB were initiated as monotherapy for hypertension. Patients were censored at discontinuation, addition, or switching of the medication.

A total of 1886 CCB and 827 ACE inhibitor/ARB users were included. After inverse probability of treatment weighting, VH incidence rates were comparable between CCB and ACE inhibitor/ARB users (7.42 vs 10.50 cases per 1000 person-years; P = .116). The 5-year cumulative incidence was 3.74% (95% confidence interval [CI], 2.59%-4.87%) and 4.17% (95% CI, 2.25%-6.05%) for CCB and ACE inhibitor/ARB users, respectively. No significant association between CCB use and VH risk was observed (adjusted subdistribution hazard ratio 0.967; 95% CI, 0.616-1.518; P = .880).

CCBs were not associated with an increased risk of VH in patients with cirrhosis compared with ACE inhibitors/ARBs. These findings suggest that CCBs are a safe treatment option for patients with cirrhosis and hypertension, providing valuable guidance on medication selection in this vulnerable population.