title: Randomized comparison of long-term losartan versus propranolol in lowering portal pressure in cirrhosis.
abstract: OBJECTIVE
  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.
authors.affiliation: Hepatic Hemodynamics Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clinic, Institut de Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Villaroel 170, 08036 Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: González-Abraldes
authors.forename: A
authors.initials: A
authors.lastname: Albillos
authors.forename: R
authors.initials: R
authors.lastname: Bañares
authors.forename: L R
authors.initials: LR
authors.lastname: Del Arbol
authors.forename: E
authors.initials: E
authors.lastname: Moitinho
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez
authors.forename: M
authors.initials: M
authors.lastname: González
authors.forename: A
authors.initials: A
authors.lastname: Escorsell
authors.forename: J C
authors.initials: JC
authors.lastname: García-Pagán
authors.forename: J
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy*; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000150:complications*; D019808:Losartan / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000008:administration & dosage* / Q000009:adverse effects; D013152:Splanchnic Circulation / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D011433:Propranolol; D003404:Creatinine; D019808:Losartan