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Antihypertensive drugs and the risk of gastrointestinal bleeding
S Suissa1, C Bourgault, A Barkun
1Department of Epidemiology and Biostatistics, McGill University, the Royal Victoria Hospital, Montreal, Québec, Canada.
Insights
Calcium channel blockers do not increase gastrointestinal bleeding risk. Beta blockers may offer protection against this adverse event, while diuretics warrant further investigation for potential risks.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Cardiovascular medications are widely prescribed.
- Gastrointestinal bleeding (GIB) is a serious adverse event.
- Previous reports suggested a link between calcium channel blockers (CCBs) and increased GIB risk.
Purpose of the Study:
- To investigate the hypothesis that CCBs increase GIB risk.
- To determine if beta blockers (BBs) decrease the risk of GIB.
- To evaluate the association between other antihypertensives and GIB.
Main Methods:
- Nested case-control study design.
- Population-based cohort of 34,074 new users of BBs, ACE inhibitors, or CCBs in Saskatchewan (1990-1993).
- 311 GIB hospitalizations identified and matched with 10 controls each; follow-up to March 1995.
Main Results:
- Overall GIB hospitalization rate was 3.0 per 1,000 person-years.
- Adjusted rate ratio for CCB use was 1.1 (95% CI 0.8-1.4), not significantly increasing GIB risk.
- Adjusted rate ratio for BB use was 0.66 (95% CI 0.44-0.98), suggesting a protective effect.
- Adjusted rate ratio for ACE inhibitors was 1.0 (95% CI 0.7-1.3).
- Adjusted rate ratio for diuretics was 1.4 (95% CI 1.0-2.0), indicating a potential increased risk.
Conclusions:
- CCB use does not appear to elevate GIB risk within the first five years of treatment.
- BBs may have a protective effect against gastrointestinal bleeding.
- The observed increased risk with diuretic use requires further research.
Purpose:
Calcium channel blockers have been reported to increase the risk of gastrointestinal bleeding. We tested this hypothesis, and also assessed whether beta blockers decrease this risk.
Subjects And Methods:
A nested case-control design within a population-based cohort of all 34,074 new users of beta blockers, angiotensin-converting enzyme (ACE) inhibitors, or calcium channel blockers in Saskatchewan, from 1990 to 1993 and followed up to March 1995, was used. We identified all 311 subjects hospitalized because of gastrointestinal bleeding during this period, each of whom was matched to 10 randomly selected controls.
Results:
The rate of hospitalization for gastrointestinal bleeding was 3.0 per 1,000 per year. The adjusted rate ratio of gastrointestinal bleeding for current use of calcium channel blockers was 1.1 (95% confidence interval [CI] 0.8 to 1.4) and 0.66 (95% CI 0.44 to 0.98) for beta blockers compared with no current use of anti-hypertensive drugs. The adjusted rate ratio for ACE inhibitor use was 1.0 (95% CI 0.7 to 1.3) while that for diuretic use was 1.4 (95% CI 1.0 to 2.0).
Conclusions:
The use of calcium channel blockers does not appear to increase the risk of gastrointestinal bleeding in the first five years of treatment, while beta blockers may prevent this adverse event. The unexpected elevated risk associated with the use of diuretics needs to be investigated further.