Document Detail


Captopril reduces portal pressure effectively in portal hypertensive patients with low portal venous velocity.
MedLine Citation:
PMID:  14714252     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The effect of an angiotensin II blockade in lowering the portal pressure in patients with liver cirrhosis and portal hypertension is controversial. This prospective study was undertaken to evaluate the portal hypotensive effect of captopril compared to that of propranolol, and to determine the factors that contribute to a successful reduction in the portal pressure after longterm captopril administration in patients with liver cirrhosis. METHODS: The hepatic venous pressure gradient (HVPG) and portal venous velocity (PVV) were measured both before and 3 months after initiation of the administration of captopril (n = 29) or propranolol (n = 29) in cirrhotic patients with a variceal bleeding episode. Patients who showed a reduction in the HVPG of more than 20% of the baseline were defined as being responders. RESULTS: At 3 months, the mean reduction in the HVPG after captopril was less than that after propranolol (-3.0 +/- 9.3% vs -28.5% +/- 4.1%; P < 0.05). However, of the 29 patients receiving captopril, 9 were classified as being responders. On multivariate analysis with parameters including age, cause, Child-Pugh score, HVPG, and PVV, only low PVV was found to be a significant independent factor for responders (PVV < 12 cm/s; odds ratio [OR], 12.2; 95% confidence interval [CI], 1.47-102.40) in the captopril group. CONCLUSIONS: Longterm captopril administration reduces the portal pressure effectively in cirrhotic patients with a low PVV. This suggests that the reduction in portal pressure after captopril administration is a result of improved portal venous outflow brought about by a decrease in the intrahepatic vascular resistance. When the PVV is below 12 cm/s, a captopril trial might be useful in preventing variceal bleeding in portal hypertensive patients.
Authors:
Soon Koo Baik; Dong Hun Park; Moon Young Kim; Yeun Jong Choi; Hyun Soo Kim; Dong Ki Lee; Sang Ok Kwon; Young Ju Kim; Joong Wha Park; Sei Jin Chang
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of gastroenterology     Volume:  38     ISSN:  0944-1174     ISO Abbreviation:  J. Gastroenterol.     Publication Date:  2003  
Date Detail:
Created Date:  2004-01-09     Completed Date:  2004-05-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9430794     Medline TA:  J Gastroenterol     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1150-4     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, 220-701 Wonju, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
Antihypertensive Agents / administration & dosage*
Blood Flow Velocity / physiology
Captopril / administration & dosage*
Drug Administration Schedule
Female
Humans
Hypertension, Portal / complications,  drug therapy*,  physiopathology
Liver Cirrhosis / complications,  physiopathology
Male
Middle Aged
Portal Pressure / drug effects*
Portal Vein / physiopathology
Propranolol / administration & dosage*
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 525-66-6/Propranolol; 62571-86-2/Captopril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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