Calcium-Channel Blockers Do Not Increase Variceal Hemorrhage Risk among hypertension patients with Cirrhosis: Study
A new study published in the journal of Clinical Gastroenterology and Hepatology showed that calcium-channel blockers (CCB) did not raise the risk of variceal hemorrhage (VH) in cirrhosis patients when compared to ACE inhibitors or angiotensin II receptor blockers (ARBs). This suggests that CCB are a fairly safe choice for controlling blood pressure in this population.
Esophageal varices and potentially fatal variceal hemorrhage are greatly increased by portal hypertension, which is typically caused by cirrhosis. Careful medication selection is necessary to manage coexisting hypertension in these individuals without raising portal pressure. The impact of calcium-channel blockers on the risk of variceal hemorrhage is still up for discussion, despite their widespread prescription.
When compared to other antihypertensives, current data indicates that CCBs do not raise the risk of variceal bleeding, which highlights the necessity for physicians to comprehend this connection in order to make better treatment decisions. Whether the vasodilatory impact of CCBs changes the risk of bleeding in cirrhosis patients is yet unknown, though. Thus, this study assessed the relationship between the usage of CCB and the risk of variceal bleeding in cirrhosis patients.
The patients with cirrhosis and no prior history of VH who were found in the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong between 2000 and 2023 were included in this territory-wide retrospective cohort research. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers were used as active comparators in an active comparator new-user design. For hypertension, either CCB or ACEI/ARB were started as monotherapy.
There were 827 ACEI/ARB users and 1,886 CCB users. VH incidence rates were similar for CCB and ACEI/ARB users after inverse probability of treatment weighting (7.42 vs. 10.50 instances per 1,000 person-years; p=0.116). For CCB and ACEI/ARB users, the 5-year cumulative incidence was 3.74% (95% CI 2.59%-4.87%) and 4.17% (95% CI 2.25%-6.05%), respectively. CCB usage and VH risk did not significantly correlate (adjusted sub distribution hazard ratio 0.967; 95% CI 0.616-1.518; p=0.880).
Overall, calcium channel blockers did not enhance the risk of variceal hemorrhage in individuals with cirrhosis when compared to ACEIs or angiotensin II receptor blockers. This suggests that calcium-channel blockers can be regarded as a secure antihypertensive alternative for this susceptible group, assisting in the selection of suitable drugs.
Source:
Dai, J., Cheuk-Fung Yip, T., Tse, Y.-K., Wing-Ki Hui, V., Lai-Hung Wong, G., Wai-Sun Wong, V., & Che-To Lai, J. (2025). Risk of variceal hemorrhage in patients with cirrhosis taking calcium-channel blockers. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association. https://doi.org/10.1016/j.cgh.2025.11.010
