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Published on: June 18, 2020

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.

The American Journal of Medicine
|September 30, 1998
PubMed

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.
Abstract

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