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Titlethe risk of gastrointestinal bleeding associated with diuretics among hypertensive persons
LanguageEnglish
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THE RISK OF GASTROINTESTINALBLEEDING ASSOCIATEDWITH

DIURETICSAMONG HYPERTENSIVEPERSONS

DANIEL BLAY

Departmentof EpidemiologyandBiostatistics

McGill University

Montreal

March2001

A thesissubmittedta theFacultyofGraduateStudiesandResearchin partial fulfillment

of the requirementsfor the degreeMasterof Science

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Table7a. Useof antihypertensivemedicationsandrateratiosfor hospitalizationfor

gastrointestinalbleedingassociatedwith currentexposureat indexdate

Antihypertensive Cases Controls Unadjusted *Adjusted tFully Adjusted
Medication n=753 n=7530 RateRatio RateRatio RateRatio

% % (95% CI)

30-dayTime Window

Reference(none) 53.52 60.44 1.00 1.00 1.00

Diuretics 36.65 25.56 1.70 1.68 1.54 (1.27- 1.86)

Thiazidecombinet 2.26 3.08 0.73 0.83 1.06 (0.60- 1.85)

Betablockers-ns 7.17 9.67 0.72 0.67 0.68 (0.32- 1.03)

Betablockers-s 1.20 2.43 0.49 0.44 0.93 (0.56- 1.42)

CC blockers 3.32 2.24 1.50 1.56 0.90 (0.65- 1.27)

Others§ 6.24 4.13 1.54 1.39 1.63 (1.13 - 2.36)

45-dayTime Window

Reference(none) 43.96 52.15 1.00 1.00 1.00

Diuretics 45.02 31.41 1.80 1.77 1.63 (1.36- 1.96)

Thiazidecombinet 2.66 3.76 0.70 0.82 1.02 (0.61 - 1.71)

Betablockers-ns 7.70 11.99 0.61 0.59 0.74 (0.54- 1.02)

Betablockers-s 1.99 2.72 0.72 0.65 0.95 (0.59- 1.52)

CC blockers 4.12 2.92 1.43 1.54 0.99 (0.55 - 1.79)

Others§ 7.57 5.06 1.53 1.38 1.73 (1.24- 2.42)

*Adjustedfor concurrentuseof differenttypesof antihypertensives;

tAdjustedfor concurrentuseof different typesof antihypertensivesandothercovariates

�~�T�h�i�a�z�i�d�e combine=anyantihypertensivesexcludingdiureticsmixed with thiazide

§Others=antihypertensivesexcludingdiuretics,betablockersandcalciumchannelblockers

none= no useof antihypertensivemedicationsduring the time window

ns= nonselective;s = selective;CC= calciumchannel

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Table7b. Useof antihypertensivemedicationsandrateratiosfor hospitalizationfor

gastrointestinalbleedingassociatedwith currentexposureat indexdate

Antihypertensive Cases Controls Unadjusted *Adjusted tFully Adjusted
Medication n=753 n=7530 RateRatio RateRatio RateRatio

% % (95% CI)

60-day Time Window

Reference(none) 39.84 47.37 1.00 1.00 1.00

Diuretics 48.47 34.93 1.77 1.73 1.52 (1.27- 1.82)

Thiazide�c�o�m�b�i�n�e�~ 3.19 4.26 0.74 0.87 1.05 (0.66- 1.69)

Betablockers-ns 8.90 13.13 0.64 0.63 0.77 (0.57- 1.05)

Betablockers-s 2.39 2.92 0.81 0.74 0.91 (0.57- 1044)

CC blockers 4.25 3.09 1040 1.50 1.16 (0.67- 2.00)

Others§ 8.50 5.55 1.57 1.43 1.64 (1.21 - 2.22)

*Adjustedfor concurrentuseof differenttypesof antihypertensives;

tAdjustedfor concurrentuseof different typesof antihypertensivesandothercovariates

:j:Thiazidecombine=anyantibypertensivesexcludingdiureticsmixed with thiazide

§Others= antihypertensivesexcludingdiuretics,betablockersandcalciumchannelblockers

none= no useof antihypertensivemedicationsduring the time window

ns= nonselective;s =selective;CC= calciumchannel

The rate ratios for the combinedeffect of selectiveandnon-selectivebetablockersafter

adjustingfor concurrentuseof otherantihypertensivemedicationsin the different time-

windowsare,30-day:0.62,95% CI, 0.46- 0.83; 45-day:0.60,95%CI, 0.46 - 0.78;

60-day:0.65,95%CI, 0.55 - 0.89(seeTable8).

Models that also adjustedfor other covariatesfactors, such as NSAIDs and anti-ulcer

drug use, anticoagulants,glucocorticoids, age at index date, gender and number of

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THIAZIDE MlXED WITH OTHER

ANTIHYPERTENSIVES

- pindolollHCTZ 13 (4.63) 21 (5.25) 25 (4.69)

- timolol/HCTZ 11 (3.91) 14 (3.50) 18(3.38)

- propranolol/HCTZ 38 (13.52) 55 (13.75) 73 (13.70)

- methyldopa/HCTZ 162(57.65) 231 (57.75) 310 (58.16)

- methyldopa/chlorthiazide 39 (13.88) 55 (13.75) 69 (12.95)

- reserpine!hydralazine/HCTZ 17 (6.05) 23 (5.75) 35 (6.57)

- reserpinelchlorthalidone 1 (0.36) 1 (0.25) 3 (0.56)

BETA BLOCKERS

Selective

- atenolol 61 (5.55) 96 (6.00) 116 (5.56)

- metoprolol 161 (14.65) 215 (13.45) 280 (13.42)

Non-selective

- propranolol 557(50.68) 823 (51.47) 1077(51.63)

- pindolol 121 (11.01) 176(11.01) 243 (11.65)

- nadolol 57(5.19) 83 (5.19) 102 (4.89)

- labetolol 8 (0.73) Il (0.69) 17(0.81)

- oxprenolol 30 (2.73) 45 (2.81) 59 (2.83)

- timolol 104(9.46) 150(9.20) 192(9.20)

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CALCIUM CHANNEL BLOCKERS

- nifedipine 112 (49.56) 162(48.65) 208 (48.71)

- diltiazem 71 (31.42) 107(32.13) 129(30.21)

- verapamil 43 (19.03) 64 (19.22) 90 (21.08)

OTHERANTIHYPERTENSIVES

- capoten(ACE inhibitor) 27 (6.68) 43 (7.23) 54 (7.01)

- methyldopa 165 (40.84) 245 (41.18) 322 (41.82)

- c10nidine 49 (12.13) 76 (12.77) 99 (12.86)

- hydralazine 81 (20.05) 113 (18.99) 145 (18.83)

- reserpine 5 (1.24) 6(1.01) 7 (0.91)

- guanethidine 4 (0.99) 5 (0.84) 5 (0.65)

- debrisoquinesulfate 4 (0.99) 6 (1.01) 7 (0.91)

- rauwolfiaserpentina 2 (0.50) 3 (0.50) 3 (0.39)

- prazosin 67 (16.58) 98 (16.47) 128 (16.62)

HCTZ = hydrochlorothiazide

ACE = angiotensin-convertingenzyme

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