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Titolo:
Randomized comparison of long-term losartan versus propranolol in loweringportal pressure in cirrhosis
Autore:
Gonzalez-Abraldes, J; Albillos, A; Banares, R; Del Arbol, LR; Moitinho, E; Rodriguez, C; Gonzalez, M; Escorsell, A; Garcia-Pagan, JC; Bosch, J;
Indirizzi:
Univ Barcelona, Liver Unit, Inst Malalties Digest,Hepat Hemodynam Lab, Hosp Clin,Inst Invest BiomedAugust Pi & Sumyer, E-08036 Barcelona, Spain Univ Barcelona Barcelona Spain E-08036 Sumyer, E-08036 Barcelona, Spain Univ Alcala de Henares, Hosp Ramon y Cajal, Gastroenterol Unit, Madrid, Spain Univ Alcala de Henares Madrid Spain , Gastroenterol Unit, Madrid, Spain Univ Complutense, Hosp Gen Univ Gregorio Maranon, Liver Unit, Hepat Hemodynam Lab, E-28040 Madrid, Spain Univ Complutense Madrid Spain E-28040 modynam Lab, E-28040 Madrid, Spain Hosp Puerta del Mar, Gastroenterol Unit, Cadiz, Spain Hosp Puerta del MarCadiz Spain l Mar, Gastroenterol Unit, Cadiz, Spain
Titolo Testata:
GASTROENTEROLOGY
fascicolo: 2, volume: 121, anno: 2001,
pagine: 382 - 388
SICI:
0016-5085(200108)121:2<382:RCOLLV>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
ANGIOTENSIN-ALDOSTERONE SYSTEM; RENAL-FUNCTION; HEPATIC HEMODYNAMICS; VARICEAL HEMORRHAGE; STELLATE CELLS; NITRIC-OXIDE; RAT-LIVER; HYPERTENSION; SPIRONOLACTONE; ASCITES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Bosch, J Univ Barcelona, Liver Unit, Inst Malalties Digest,Hepat HemodynamLab, Hosp Clin,Inst Invest BiomedAugust Pi & Sumyer, Villarroel 170, E-08036 Barcelona, Spain Univ Barcelona Villarroel 170 Barcelona Spain E-08036 ona, Spain
Citazione:
J. Gonzalez-Abraldes et al., "Randomized comparison of long-term losartan versus propranolol in loweringportal pressure in cirrhosis", GASTROENTY, 121(2), 2001, pp. 382-388

Abstract

Background & Aims: It has been suggested that losartan, an angiotensin II (A-II) type I 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 (-1.0%+/-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 therapywere 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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Documento generato il 31/03/20 alle ore 19:38:04