Faculty Collaboration Database

Risk of hospitalized gastrointestinal bleeding in persons randomized to diuretic, ACE-inhibitor, or calcium-channel blocker in ALLHAT. J Clin Hypertens (Greenwich) 2013 Nov;15(11):825-32

Date

11/29/2013

Pubmed ID

24283598

Pubmed Central ID

PMC3844932

DOI

10.1111/jch.12180

Scopus ID

2-s2.0-84886952643 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

Calcium channel blockers (CCBs) are an important class of medication useful in the treatment of hypertension. Several observational studies have suggested an association between CCB therapy and gastrointestinal (GI) hemorrhage. Using administrative databases, the authors re-examined in a post-hoc analysis whether the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants randomized to the CCB amlodipine had a greater risk of hospitalized GI bleeding (a prespecified outcome) compared with those randomized to the diuretic chlorthalidone or the angiotensin-converting enzyme inhibitor lisinopril. Participants randomized to chlorthalidone did not have a reduced risk for GI bleeding hospitalizations compared with participants randomized to amlodipine (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.92-1.28). Those randomized to lisinopril were at increased risk of GI bleeding compared with those randomized to chlorthalidone (HR, 1.16; 95% CI, 1.00-1.36). In a post-hoc comparison, participants assigned to lisinopril therapy had a higher risk of hospitalized GI hemorrhage (HR, 1.27; 95% CI, 1.06-1.51) vs those assigned to amlodipine. In-study use of atenolol prior to first GI hemorrhage was related to a lower incidence of GI bleeding (HR, 0.69; 95% CI, 0.57-0.83). Hypertensive patients on amlodipine do not have an increased risk of GI bleeding hospitalizations compared with those taking either chlorthalidone or lisinopril.

Author List

Phillips W, Piller LB, Williamson JD, Whittle J, Jafri SZ, Ford CE, Einhorn PT, Oparil S, Furberg CD, Grimm RH Jr, Alderman MH, Davis BR, Probstfield JL, ALLHAT Collaborative Research Group

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Amlodipine
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Calcium Channel Blockers
Chlorthalidone
Diuretics
Female
Gastrointestinal Hemorrhage
Hospitalization
Humans
Hypertension
Incidence
Lisinopril
Male
Middle Aged
Myocardial Infarction
Risk Factors
Treatment Outcome