This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (18)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Robert C. Kaplan, PhD; Susan R. Heckbert, MD, PhD; Thomas D. Koepsell, MD, MPH; Frits R. Rosendaal, MD, PhD; Bruce M. Psaty, MD, PhD

Arch Intern Med. 2000;160:1849-1855.

Background  We conducted a case-control study of the association between calcium channel blocker use and gastrointestinal (GI) tract bleeding in hypertensive members of a health maintenance organization.

Methods  Case patients (n=174) were treated hypertensive health maintenance organization members hospitalized for GI tract bleeding between January 1992 and December 1994. Case patients were identified using computerized diagnosis codes and were confirmed by medical record review. Control subjects (n=771) were treated hypertensive members selected from ongoing studies at the health maintenance organization. Computerized pharmacy data and medical records were used to assess medication use and other risk factors for GI tract bleeding.

Results  Compared with -blocker users, calcium channel blocker users had an age-, sex- and calendar year–adjusted relative risk (RR) of GI tract bleeding of 2.60 (95% confidence interval [CI], 1.71-3.96). The RR associated with calcium channel blocker use was 2.05 (95% CI, 1.33-3.17) after further adjustment for number of recent visits, diastolic blood pressure, chronic congestive heart failure, and duration of hypertension. No significant dose-response relationship was observed. Compared with -blocker users, angiotensin-converting enzyme inhibitor users had an RR of 1.22 (95% CI, 0.75-1.97). Calcium channel blocker use tended to be more strongly associated with risk of lower GI tract bleeding (RR, 2.56; 95% CI, 1.08-6.05) than with risk of upper GI tract bleeding (RR, 1.54; 95% CI, 0.91-2.59) or peptic ulcer–related bleeding (RR, 1.17; 95% CI, 0.62-2.21), although these results were compatible with chance.

Conclusions  Calcium channel blocker use might be associated with an elevated risk of GI tract bleeding. These findings require confirmation in randomized studies.

From the Cardiovascular Health Research Unit (Drs Kaplan, Heckbert, Koepsell, Rosendaal, and Psaty) and the Departments of Epidemiology (Drs Kaplan, Heckbert, Koepsell, Rosendaal, and Psaty), Medicine (Drs Koepsell and Psaty), and Health Services (Drs Koepsell and Psaty), University of Washington, Seattle; and the Department of Clinical Epidemiology, University Hospital Leiden, Leiden, the Netherlands (Dr Rosendaal). Dr Kaplan is now with the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(12):1879-1880.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Medication and Dosage Considerations in the Prophylaxis and Treatment of High-Altitude Illness
Luks and Swenson
Chest 2008;133:744-755.
ABSTRACT | FULL TEXT  

Intractable Epistaxis Associated with Topiramate Administration
Page and Bainbridge
The Annals of Pharmacotherapy 2006;40:1462-1465.
ABSTRACT | FULL TEXT  

Epidemiologic Review of the Calcium Channel Blocker Drugs: An Up-to-date Perspective on the Proposed Hazards
Kizer and Kimmel
Arch Intern Med 2001;161:1145-1158.
ABSTRACT | FULL TEXT