Article ID: nt.2018-1820
The present study aimed to provide clear evidence on the risk of reflux esophagitis (RE) from the use of dihydropyridine calcium channel blockers (dCCB), a class of antihypertensive drugs. We evaluated the incidence of RE with each type of dCCB (L-type, N-type, and T-type) and with varying dosages and durations of use by comparing them with angiotensin II receptor blockers. It was found that L-type dCCB such as amlodipine and nifedipine had significantly higher RE incidence rates starting from low doses, and that the RE incidence rose significantly with dependence on the duration of use. In contrast, cilnidipine and benidipine, which act additionally to block N-type calcium channels in the sympathetic nerve endings, and azelnidipine, which weakly potentiates reflex sympathetic nerves, did not show a significant rise in RE incidence rate by dose or duration of use. N-type calcium channel blockers inhibit the relaxation of the lower esophageal sphincter, which is closely related to the occurrence of RE. This inhibitory effect was suggested as the reason that RE incidence rates were lower for cilnidipine, benidipine, and azelnidipine than for amlodipine and nifedipine, which are highly specific L-type channel blockers.
