Document Detail


Chronic administration of losartan, an angiotensin II receptor antagonist, is not effective in reducing portal pressure in patients with preascitic cirrhosis.
MedLine Citation:
PMID:  15046234     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Plasma angiotensin II (ANG II) concentrations are elevated in cirrhosis and have been implicated as a cause of portal hypertension. We aimed to study both the systemic and portal hemodynamics, and tolerability after chronic administration of losartan, an ANG II receptor antagonist. METHODS: Twelve patients with preascitic cirrhosis were studied: mean age of 53.8 +/- 3.3 yr; average Child-Pugh score of 5.8 +/- 0.3; alcohol etiology (5), hepatitis B/C (1/3), primary biliary cirrhosis (3). No patients were on diuretics or vasoactive medication. Hemodynamic measurements were performed at baseline and 4 weeks after daily administration of 25 mg losartan. RESULTS: There was no significant change in the hepatic venous pressure gradient (15.4 +/- 1.5 to 13.6 +/- 1.6 mmHg, -11.7%, p = NS), despite a significant reduction in the wedge hepatic venous pressure (20.3 +/- 1.8 to 17.3 +/- 1.8 mmHg, -14.8%, p < 0.05). Cardiac output, hepatic blood flow, systemic vascular resistance, creatinine clearance, and natriuresis were unaffected. The plasma renin activity increased significantly from 2.7 +/- 0.4 to 5.2 +/- 1.1 ng/ml/h (p < 0.05). There was a significant reduction in the mean arterial pressure from 96.9 +/- 3.3 to 89.3 +/- 3.5 mmHg, -7.8 +/- 3.0% (p = 0.02), with 1 patient experiencing symptomatic hypotension. CONCLUSIONS: Chronic administration of low-dose losartan does not lead to a significant reduction in the portal pressure gradient. Losartan is unlikely to be useful in the management of patients with early cirrhosis, who are at risk of variceal bleeding.
Authors:
Dhiraj Tripathi; George Therapondos; Hock F Lui; Neil Johnston; David J Webb; Peter C Hayes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  99     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-03-29     Completed Date:  2004-05-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  390-4     Citation Subset:  IM    
Affiliation:
Liver Unit, Department of Medicine, Royal Infirmary, Edinburgh, UK.
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / pharmacology,  therapeutic use*
Female
Hemodynamics
Humans
Hypertension, Portal / drug therapy*,  etiology,  physiopathology
Kidney / physiopathology
Liver Cirrhosis / complications,  drug therapy*,  physiopathology
Losartan / pharmacology,  therapeutic use*
Male
Middle Aged
Portal Pressure / drug effects*
Receptors, Angiotensin / antagonists & inhibitors*
Renin-Angiotensin System / physiology
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Receptors, Angiotensin; 114798-26-4/Losartan
Comments/Corrections
Comment In:
Am J Gastroenterol. 2004 Nov;99(11):2282-3   [PMID:  15555016 ]

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