Hamada A, Ishii J, Doi K, Hamada N, Miyazaki C, Hamada T, Ohwaki Y, Wada M, Nakashima K
Health Care Pharmacy Ltd.
J Clin Pharm Ther. 2008 Dec;33(6):619-24. doi: 10.1111/j.1365-2710.2008.00958.x.
Calcium channel blockers (CCBs) have been widely used for the treatment of hypertension and angina pectoris. It is presumed that CCBs decrease the lower esophageal sphincter pressure and as a result, the risk of gastrointestinal disease may be increased. Since the prevalence of gastrointestinal diseases has increased in elderly patients, it is possible that treatment with CCBs may have contributed to this increase. Therefore, we considered that the risk of exacerbating gastrointestinal disease among elderly patients by CCBs can be estimated by using the prescription ratio of antisecretory drugs as an outcome.
We hypothesized that patients who are prescribed CCBs would increase the use of antisecretory drugs involving H(2)-receptor antagonists and proton pump inhibitors (PPIs). From January 2001 to December 2005, a dynamic retrospective cohort study was performed at three community pharmacies in Nagasaki city, Japan, to assess the use of antisecretory drugs following treatment with CCBs among elderly patients. The correlation of initiation of antisecretory drugs treatment to maintenance therapy with PPIs was determined by the Cox proportional hazards model.
The proposed study includes 303 patients prescribed CCBs and 258 controls. During the study period, 138 patients prescribed CCBs and 66 controls were initiated by giving antisecretory drugs; the hazard ratio was 1.40 (95% confidence interval 1.21-1.63). Eighty two patients taking CCBs and 32 controls were initiated by the maintenance therapy with PPIs; the hazard ratio was 1.48 (95% confidence interval 1.21-1.83).
Patients who simultaneously initiated the use of antisecretory drugs with CCBs could not be found. Therefore, antisecretory drugs have not been used to prevent the gastrointestinal diseases caused by CCBs. The results obtained in this study suggest that the risk of gastrointestinal disease could be increased by long-term treatment with CCBs for elderly patients.
钙通道阻滞剂（CCBs）已被广泛用于治疗高血压和心绞痛。据推测，CCBs会降低食管下括约肌压力，因此，胃肠道疾病的风险可能会增加。由于老年患者胃肠道疾病的患病率有所上升，CCBs治疗可能促成了这一增长。因此，我们认为可以通过使用抗分泌药物的处方率作为结果来估计CCBs在老年患者中加重胃肠道疾病的风险。
我们假设，开具CCBs处方的患者会增加使用涉及H(2)受体拮抗剂和质子泵抑制剂（PPIs）的抗分泌药物。2001年1月至2005年12月，在日本长崎市的三家社区药店进行了一项动态回顾性队列研究，以评估老年患者接受CCBs治疗后抗分泌药物的使用情况。抗分泌药物治疗起始与PPIs维持治疗之间的相关性通过Cox比例风险模型确定。
本拟研究纳入了303例开具CCBs处方的患者和258例对照。在研究期间，138例开具CCBs处方的患者和66例对照开始使用抗分泌药物；风险比为1.40（95%置信区间1.21 - 1.63）。82例服用CCBs的患者和32例对照开始接受PPIs维持治疗；风险比为1.48（95%置信区间1.21 - 1.83）。
未发现同时开始使用CCBs和抗分泌药物的患者。因此，抗分泌药物尚未用于预防CCBs引起的胃肠道疾病。本研究结果表明，长期使用CCBs治疗老年患者可能会增加胃肠道疾病的风险。
