Major upper gastrointestinal bleeding and the use of calcium channel blockers

Kelly, Judith P.; László, András; Kaufman, David W.; Sundström, Anders; Shapiro, Samuel

doi:10.1016/s0140-6736(98)05202-7

Cited by 21 publications

(32 citation statements)

References 4 publications

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“…the difference in rates of bleeding between CCB users, beta blocker users and those who used neither drug disappeared. The result of another case-control study by Kelly et al 16 confirmed Smalley's data. Kelly et al 16 reported that the elevated unadjusted risk of upper gastrointestinal bleeding associated with CCB use was due to confounding by the concurrent use of ASA.…”

Section: Discussionsupporting

confidence: 62%

“…The result of another case-control study by Kelly et al 16 confirmed Smalley's data. Kelly et al 16 reported that the elevated unadjusted risk of upper gastrointestinal bleeding associated with CCB use was due to confounding by the concurrent use of ASA. Weil et al 18 used a large case-control study to determine risk factors for peptic ulcer bleeding other than NSAIDs (ASA and non-ASA).…”

Section: Discussionsupporting

confidence: 62%

“…1,5,10,24,25 Many reports, most case-control studies, investigated whether use of CCBs was associated with a higher risk of (gastrointestinal) bleeding. 5,12,[15][16][17][18][19] Several in vitro studies reported that the concurrent administration of (a low dose of) ASA or another NSAID with a CCB synergistically inhibits platelet aggregation [26][27][28][29] while in vivo experiments showed inconsistent results. 30,31 However, the question of an interaction between CCB intake and NSAID intake on the incidence of bleeding was not specifically addressed in any study.…”

Section: Discussionmentioning

confidence: 99%

“…13 Furthermore, in a prospective cohort study, Pahor et al 14 reported an increased risk of upper gastrointestinal bleeding associated with the use of CCBs, but several other investigators, using data from cohort 12 or casecontrol studies [15][16][17][18][19] could not confirm Pahor's results. 14 In this post-hoc analysis of the Syst-Eur data we examined the relationship between NSAID intake and outcome.…”

Section: Journal Of Human Hypertension (2001) 15 613-618mentioning

confidence: 98%

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Interaction between nonsteroidal anti-inflammatory drug intake and calcium-channel blocker-based antihypertensive treatment in the Syst-Eur trial

et al. 2001

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Objective: To assess the relationship between chronic intake of nonsteroidal anti-inflammatory drugs (NSAID) and outcome, in particular (gastrointestinal) bleeding and to investigate whether the effect of chronic NSAID intake was similar in untreated and treated elderly hypertensives. Methods: Eligible patients (у60 years, with systolic blood pressure 160-219 mm Hg and diastolic blood pressure Ͻ95 mm Hg) were randomised to active treatment or placebo. Active treatment consisted of nitrendipine, with the possible addition of enalapril, hydrochlorothiazide, or both, titrated or combined to reduce the sitting systolic blood pressure by at least 20 mm Hg to below 150 mm Hg. Patients never taking NSAIDs (n ‫؍‬ 2882) were compared with patients on chronic NSAID intake (n ‫؍‬ 861), defined as reporting NSAID intake on at least 50% of the patient forms.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Journal Of Human Hypertension (2001) 15 613-618mentioning

confidence: 98%

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Interaction between nonsteroidal anti-inflammatory drug intake and calcium-channel blocker-based antihypertensive treatment in the Syst-Eur trial

et al. 2001

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“…However, an (Ϸ20%) excess of GI bleeding was observed among individuals assigned to lisinopril compared with amlodipine. This finding is at odds with the observations by Pahor et al 11 and Zuccala et al 12 Other investigators 27,28 have reported observations contrary to those of Pahor et al 11 and Zuccala et al 12 as well. Fogari et al 29 suggest that plasma fibrinogen levels are significantly decreased by treatment with lisinopril, providing a plausible mechanism to explain our observation.…”

Section: Leenen Et Al Ccb Vs Ace-inhibitor Results In Allhat 379mentioning

confidence: 69%

Clinical Events in High-Risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-Converting Enzyme Inhibitor in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

et al. 2006

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Abstract-The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (nϭ9048) or lisinopril (nϭ9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RRϭ1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RRϭ1.07, 95% CI 0.89 to 1.28), and in women (RRϭ1.45, 95% CI 1.17 to 1.79), but not in men (RRϭ1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RRϭ1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RRϭ0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm. Key Words: antihypertensive therapy Ⅲ hypertension, detection and control Ⅲ calcium channel blockers Ⅲ angiotensin-converting enzyme Ⅲ cardiovascular diseases Ⅲ stroke Ⅲ heart failure T he success in the management of hypertension and prevention of its sequelae is owed, in part, to the many antihypertensive drugs available to physicians and patients. By the early 1990s, all of the classes of antihypertensive drugs were shown effective in lowering blood pressure (BP), but few morbidity and mortality efficacy data were available except for thiazide-type diuretics and ␤-blockers. Angiotensin-converting enzyme (ACE) inhib-

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Use of Calcium Channel Blockers and Risk of Hospitalized Gastrointestinal Tract Bleeding

Kaplan¹,

Heckbert²,

Koepsell³

et al. 2000

Arch Intern Med

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Major upper gastrointestinal bleeding and the use of calcium channel blockers

Cited by 21 publications

References 4 publications

Interaction between nonsteroidal anti-inflammatory drug intake and calcium-channel blocker-based antihypertensive treatment in the Syst-Eur trial

Interaction between nonsteroidal anti-inflammatory drug intake and calcium-channel blocker-based antihypertensive treatment in the Syst-Eur trial

Clinical Events in High-Risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-Converting Enzyme Inhibitor in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Use of Calcium Channel Blockers and Risk of Hospitalized Gastrointestinal Tract Bleeding

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