CCBs not associated with variceal haemorrhage in cirrhosis

Patients with cirrhosis using calcium channel blockers (CCBs) are not at increased risk of variceal haemorrhage, as reported in a retrospective study.

Researchers used data from Hong Kong’s Clinical Data Analysis and Reporting System of the Hospital Authority and looked at patients with cirrhosis and no history of variceal haemorrhage. They established two cohorts, those who initiated CCBs or angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) as monotherapy for hypertension. Patients were censored at discontinuation, addition, or switching of the medication.

The analysis included 1,886 CCB users and 827 ACEI/ARB users. After inverse probability of treatment weighting, the incidence rates of variceal haemorrhage did not significantly differ between CCB users and ACEI/ARB users (7.42 vs 10.50 cases per 1,000 person-years; p=0.116).

The 5-year cumulative incidence of variceal haemorrhage was 3.74 percent (95 percent confidence interval [CI], 2.59–4.87) among CCB users and 4.17 percent (95 percent CI, 2.25–6.05) among ACEI/ARB users.

CCB use showed a null association with the risk of variceal haemorrhage when compared with ACEI/ARB use (adjusted subdistribution hazard ratio, 0.967, 95 percent CI, 0.616–1.518; p=0.880).

These findings demonstrate the safety of CCBs for patients with cirrhosis and hypertension and provide valuable guidance on medication selection in this vulnerable population.