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Risk of Hospitalized Gastrointestinal Bleeding in Persons Randomized to Diuretic, ACE-Inhibitor, or Calcium-Channel Blocker in ALLHAT

Authors :
Syed Z. A. Jafri
Linda B. Piller
Michael H. Alderman
Paula T. Einhorn
Jeff D. Williamson
William Phillips
Jeffrey L. Probstfield
Curt D. Furberg
Suzanne Oparil
Jeff Whittle
Richard H. Grimm
Barry R. Davis
Charles E. Ford
Source :
The Journal of Clinical Hypertension. 15:825-832
Publication Year :
2013
Publisher :
Wiley, 2013.

Abstract

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

Details

ISSN :
15246175
Volume :
15
Database :
OpenAIRE
Journal :
The Journal of Clinical Hypertension
Accession number :
edsair.doi.dedup.....73dbb6f841b416177b290a2b9ba7b24e
Full Text :
https://doi.org/10.1111/jch.12180