Document Detail


A randomized study of losartan vs propranolol: Effects on hepatic and systemic hemodynamics in cirrhotic patients.
MedLine Citation:
PMID:  15094704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: The potential use of losartan, an angiotensin II type 1 receptor blocker, in the treatment of portal hypertension is still under debate. This randomized controlled trial compared the effects of losartan vs. propranolol on portal and systemic hemodynamics in patients with cirrhosis.
METHODS: Twenty-seven compensated patients were randomized to receive losartan 25 mg/day (n = 17) or propranolol (n = 10). Hepatic venous pressure gradient (HVPG), portal blood flow (Doppler duplex ultrasound) and systemic hemodynamics were measured at baseline and after 12-week treatment. Portal resistance was calculated as HVPG/portal blood flow.
RESULTS: Propranolol induced a reduction in cardiac output (p 0.002), heart rate (p 0.0001) and HVPG [from 16.4 (+/- 4.1) to 13.1 (+/- 3.6) mmHg (p 0.07)]; six patients showed a reduction equal or greater than 20% and were considered responders. Losartan caused a decrease in HVPG [from 15.6 (+/- 4.2) to 11.8 (+/- 3.5) mmHg (p 0.002)], without changes in portal blood flow and systemic hemodynamics. Changes in HVPG correlated with variations in portal resistance (r 0.88, p < 0.0001). Losartan induced a reduction in HVPG between 10 and 19% in 5/17 patients, and 20% or more in 8/17. Five out of eight patients who respond to losartan showed severe portal hypertension, with higher baseline HVPG (equal or greater than 16 mmHg).
CONCLUSIONS: the administration of losartan in a doses of 25 mg per day may be effective in lowering portal pressure in patients with compensated cirrhosis, particularly in those with more severe portal hypertension.
Authors:
Gustavo Castaño; Pedro Viudez; Miguel Riccitelli; Silvia Sookoian
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Annals of hepatology     Volume:  2     ISSN:  1665-2681     ISO Abbreviation:  Ann Hepatol     Publication Date:    2003 Jan-Mar
Date Detail:
Created Date:  2004-04-19     Completed Date:  2004-06-08     Revised Date:  2013-05-16    
Medline Journal Info:
Nlm Unique ID:  101155885     Medline TA:  Ann Hepatol     Country:  Mexico    
Other Details:
Languages:  eng     Pagination:  36-40     Citation Subset:  IM    
Affiliation:
Liver Unit, Department of Internal Medicine, Hospital Argerich, Alen 963, Burzaco (1852), Buenos Aires, Argentina. castano@intramed.ent
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antihypertensive Agents / therapeutic use*
Female
Hemodynamics / drug effects
Humans
Hypertension, Portal / drug therapy*,  etiology,  physiopathology,  ultrasonography
Liver Cirrhosis / complications,  drug therapy*,  physiopathology
Losartan / therapeutic use*
Male
Middle Aged
Portal Vein / ultrasonography
Propranolol / therapeutic use*
Splanchnic Circulation
Treatment Outcome
Ultrasonography, Doppler, Duplex
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 114798-26-4/Losartan; 525-66-6/Propranolol

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


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