Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in cirrhosis
Background & Aims: It has been suggested that losartan, an angiotensin II (A-II) type 1 receptor blocker, may have a pronounced portal pressure reducing effect, far greater than that of propranolol.This randomized controlled trial compared the hemodynamic and renal effects of continued 6-week ad...
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| Veröffentlicht in: | Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2001-08, Vol.121 (2), p.382-388 |
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| creator | González-Abraldes, Juan Albillos, Agustin Bañares, Rafael Del Arbol, Luis Ruiz Moitinho, Eduardo Rodríguez, Claudio González, Monica Escorsell, Angels García-Pagán, Juan Carlos Bosch, Jaume |
| description | Background & Aims: It has been suggested that losartan, an angiotensin II (A-II) type 1 receptor blocker, may have a pronounced portal pressure reducing effect, far greater than that of propranolol.This randomized controlled trial compared the hemodynamic and renal effects of continued 6-week administration of losartan (n = 25) vs.propranolol (n = 15) in portal hypertensive patients with cirrhosis treated endoscopically after a variceal bleeding episode.Methods: Hepatic venous pressure gradient (HVPG), systemic hemodynamics, renal function, and vasoactive factors were measured before and at 6 weeks of treatment.Results: Losartan did not reduce HVPG (−2% ± 12%, NS) but significantly decreased mean arterial pressure (MAP, −8% ± 10%, P = 0.001).On the contrary, propranolol significantly reduced HVPG (−10% ± 11%, P = 0.003) and cardiac output (−16% ± 12%, P = 0.001) but did not modify MAP (2.5% ± 10%, NS).Losartan increased A-II levels, reduced aldosterone, and decreased glomerular filtration rate (GFR) in Child B patients.Propranolol did not modify renal function.Adverse events related to therapy were mild and similar in both groups.Conclusions: Unlike propranolol, long-term losartan administration does not significantly reduce HVPG in patients with cirrhosis treated after a variceal bleeding episode, and it caused hypotension and reduced GFR in patients with moderate liver failure.Therefore, losartan is not an alternative to propranolol in preventing variceal rebleeding.
GASTROENTEROLOGY 2001;121:382-388 |
| doi_str_mv | 10.1053/gast.2001.26288 |
| format | Article |
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GASTROENTEROLOGY 2001;121:382-388</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/gast.2001.26288</identifier><identifier>PMID: 11487547</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Antihypertensive Agents - administration & dosage ; Antihypertensive Agents - adverse effects ; Blood Pressure - drug effects ; Blood Urea Nitrogen ; Creatinine - blood ; Female ; Glomerular Filtration Rate - drug effects ; Humans ; Hypertension, Portal - drug therapy ; Liver Circulation - drug effects ; Liver Cirrhosis - complications ; Losartan - administration & dosage ; Losartan - adverse effects ; Male ; Middle Aged ; Propranolol - administration & dosage ; Propranolol - adverse effects ; Splanchnic Circulation - drug effects</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2001-08, Vol.121 (2), p.382-388</ispartof><rights>2001 American Gastroenterological Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-7a4fab0763099f287a11a5c1af12762210e57f35a53a5d222c68ca038a2f1fa23</citedby><cites>FETCH-LOGICAL-c382t-7a4fab0763099f287a11a5c1af12762210e57f35a53a5d222c68ca038a2f1fa23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016508501635285$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11487547$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>González-Abraldes, Juan</creatorcontrib><creatorcontrib>Albillos, Agustin</creatorcontrib><creatorcontrib>Bañares, Rafael</creatorcontrib><creatorcontrib>Del Arbol, Luis Ruiz</creatorcontrib><creatorcontrib>Moitinho, Eduardo</creatorcontrib><creatorcontrib>Rodríguez, Claudio</creatorcontrib><creatorcontrib>González, Monica</creatorcontrib><creatorcontrib>Escorsell, Angels</creatorcontrib><creatorcontrib>García-Pagán, Juan Carlos</creatorcontrib><creatorcontrib>Bosch, Jaume</creatorcontrib><title>Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in cirrhosis</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><description>Background & Aims: It has been suggested that losartan, an angiotensin II (A-II) type 1 receptor blocker, may have a pronounced portal pressure reducing effect, far greater than that of propranolol.This randomized controlled trial compared the hemodynamic and renal effects of continued 6-week administration of losartan (n = 25) vs.propranolol (n = 15) in portal hypertensive patients with cirrhosis treated endoscopically after a variceal bleeding episode.Methods: Hepatic venous pressure gradient (HVPG), systemic hemodynamics, renal function, and vasoactive factors were measured before and at 6 weeks of treatment.Results: Losartan did not reduce HVPG (−2% ± 12%, NS) but significantly decreased mean arterial pressure (MAP, −8% ± 10%, P = 0.001).On the contrary, propranolol significantly reduced HVPG (−10% ± 11%, P = 0.003) and cardiac output (−16% ± 12%, P = 0.001) but did not modify MAP (2.5% ± 10%, NS).Losartan increased A-II levels, reduced aldosterone, and decreased glomerular filtration rate (GFR) in Child B patients.Propranolol did not modify renal function.Adverse events related to therapy were mild and similar in both groups.Conclusions: Unlike propranolol, long-term losartan administration does not significantly reduce HVPG in patients with cirrhosis treated after a variceal bleeding episode, and it caused hypotension and reduced GFR in patients with moderate liver failure.Therefore, losartan is not an alternative to propranolol in preventing variceal rebleeding.
GASTROENTEROLOGY 2001;121:382-388</description><subject>Adult</subject><subject>Antihypertensive Agents - administration & dosage</subject><subject>Antihypertensive Agents - adverse effects</subject><subject>Blood Pressure - drug effects</subject><subject>Blood Urea Nitrogen</subject><subject>Creatinine - blood</subject><subject>Female</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Humans</subject><subject>Hypertension, Portal - drug therapy</subject><subject>Liver Circulation - drug effects</subject><subject>Liver Cirrhosis - complications</subject><subject>Losartan - administration & dosage</subject><subject>Losartan - adverse effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Propranolol - administration & dosage</subject><subject>Propranolol - adverse effects</subject><subject>Splanchnic Circulation - drug effects</subject><issn>0016-5085</issn><issn>1528-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LAzEQhoMotlbP3mT_wLZJttlNj1L8goIgeg7TbLJGdpNlsq3orzdrC548zTDvB8NDyDWjc0ZFsWggDnNOKZvzkkt5QqZMcJmnAz8l0zTKXFApJuQixg9K6aqQ7JxMGFvKSiyrKWlewNehc9-mznToekAXg8-Czdrgm3ww2KUtAg7gs73BuItZj6FH8KENbeZ8kj8NOt9kfUiuNskmxh2aUdMO8T1EFy_JmYU2mqvjnJG3-7vX9WO-eX54Wt9ucl1IPuQVLC1saVUWdLWyXFbAGAjNwDJelZwzakRlCwGiAFFzznUpNdBCArfMAi9mZHHo1RhiRGNVj64D_FKMqhGZGpGpEZn6RZYSN4dEv9t2pv7zHxklw-pgMOnvvTOoonbGa1M7NHpQdXD_lv8AB9N9fQ</recordid><startdate>200108</startdate><enddate>200108</enddate><creator>González-Abraldes, Juan</creator><creator>Albillos, Agustin</creator><creator>Bañares, Rafael</creator><creator>Del Arbol, Luis Ruiz</creator><creator>Moitinho, Eduardo</creator><creator>Rodríguez, Claudio</creator><creator>González, Monica</creator><creator>Escorsell, Angels</creator><creator>García-Pagán, Juan Carlos</creator><creator>Bosch, Jaume</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>200108</creationdate><title>Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in cirrhosis</title><author>González-Abraldes, Juan ; Albillos, Agustin ; Bañares, Rafael ; Del Arbol, Luis Ruiz ; Moitinho, Eduardo ; Rodríguez, Claudio ; González, Monica ; Escorsell, Angels ; García-Pagán, Juan Carlos ; Bosch, Jaume</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-7a4fab0763099f287a11a5c1af12762210e57f35a53a5d222c68ca038a2f1fa23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Antihypertensive Agents - administration & dosage</topic><topic>Antihypertensive Agents - adverse effects</topic><topic>Blood Pressure - drug effects</topic><topic>Blood Urea Nitrogen</topic><topic>Creatinine - blood</topic><topic>Female</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Humans</topic><topic>Hypertension, Portal - drug therapy</topic><topic>Liver Circulation - drug effects</topic><topic>Liver Cirrhosis - complications</topic><topic>Losartan - administration & dosage</topic><topic>Losartan - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Propranolol - administration & dosage</topic><topic>Propranolol - adverse effects</topic><topic>Splanchnic Circulation - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>González-Abraldes, Juan</creatorcontrib><creatorcontrib>Albillos, Agustin</creatorcontrib><creatorcontrib>Bañares, Rafael</creatorcontrib><creatorcontrib>Del Arbol, Luis Ruiz</creatorcontrib><creatorcontrib>Moitinho, Eduardo</creatorcontrib><creatorcontrib>Rodríguez, Claudio</creatorcontrib><creatorcontrib>González, Monica</creatorcontrib><creatorcontrib>Escorsell, Angels</creatorcontrib><creatorcontrib>García-Pagán, Juan Carlos</creatorcontrib><creatorcontrib>Bosch, Jaume</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>González-Abraldes, Juan</au><au>Albillos, Agustin</au><au>Bañares, Rafael</au><au>Del Arbol, Luis Ruiz</au><au>Moitinho, Eduardo</au><au>Rodríguez, Claudio</au><au>González, Monica</au><au>Escorsell, Angels</au><au>García-Pagán, Juan Carlos</au><au>Bosch, Jaume</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in cirrhosis</atitle><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle><addtitle>Gastroenterology</addtitle><date>2001-08</date><risdate>2001</risdate><volume>121</volume><issue>2</issue><spage>382</spage><epage>388</epage><pages>382-388</pages><issn>0016-5085</issn><eissn>1528-0012</eissn><abstract>Background & Aims: It has been suggested that losartan, an angiotensin II (A-II) type 1 receptor blocker, may have a pronounced portal pressure reducing effect, far greater than that of propranolol.This randomized controlled trial compared the hemodynamic and renal effects of continued 6-week administration of losartan (n = 25) vs.propranolol (n = 15) in portal hypertensive patients with cirrhosis treated endoscopically after a variceal bleeding episode.Methods: Hepatic venous pressure gradient (HVPG), systemic hemodynamics, renal function, and vasoactive factors were measured before and at 6 weeks of treatment.Results: Losartan did not reduce HVPG (−2% ± 12%, NS) but significantly decreased mean arterial pressure (MAP, −8% ± 10%, P = 0.001).On the contrary, propranolol significantly reduced HVPG (−10% ± 11%, P = 0.003) and cardiac output (−16% ± 12%, P = 0.001) but did not modify MAP (2.5% ± 10%, NS).Losartan increased A-II levels, reduced aldosterone, and decreased glomerular filtration rate (GFR) in Child B patients.Propranolol did not modify renal function.Adverse events related to therapy were mild and similar in both groups.Conclusions: Unlike propranolol, long-term losartan administration does not significantly reduce HVPG in patients with cirrhosis treated after a variceal bleeding episode, and it caused hypotension and reduced GFR in patients with moderate liver failure.Therefore, losartan is not an alternative to propranolol in preventing variceal rebleeding.
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| ispartof | Gastroenterology (New York, N.Y. 1943), 2001-08, Vol.121 (2), p.382-388 |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Alma/SFX Local Collection |
| subjects | Adult Antihypertensive Agents - administration & dosage Antihypertensive Agents - adverse effects Blood Pressure - drug effects Blood Urea Nitrogen Creatinine - blood Female Glomerular Filtration Rate - drug effects Humans Hypertension, Portal - drug therapy Liver Circulation - drug effects Liver Cirrhosis - complications Losartan - administration & dosage Losartan - adverse effects Male Middle Aged Propranolol - administration & dosage Propranolol - adverse effects Splanchnic Circulation - drug effects |
| title | Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in cirrhosis |
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