title: Effects of long-term Irbesartan in reducing portal pressure in cirrhotic patients: comparison with propranolol in a randomised controlled study.
abstract: OBJECTIVE
  The role of angiotensin II (AT-II) type I receptor antagonists in the treatment of portal hypertension remains controversial. We tested the efficacy of Irbesartan (Irb) vs. Propranolol (Pro) in reducing portal pressure and evaluated its systemic haemodynamic effects.
  
  
  METHODS
  Thirty-four patients were randomly assigned to receive either Irb 300 mg/day (19 patients) or Pro 40-120 mg/day (15 patients) for 2 months.
  
  
  RESULTS
  Irb was discontinued in five patients (26%). No major side effect occurred in the Pro group. On an average, the portal pressure gradient decreased significantly more in the Pro than in the Irb group (median -19.5%, range -11/-31% vs. -4.8%, +2.5/-10%, P<0.001). A clinically significant decrease was seen in one (7%) of the patients given Irb vs. five (33%) given Pro (P<0.02). The fall in mean arterial pressure was significantly higher with Irb than with Pro (median -29%, range -15/-45% vs. -4.9%, +8/-19%, P<0.02). Irb significantly modified the blood creatinine clearance (median -29 ml/m, range +9/-61 ml/m, -30, -24/-35% P<0.0001 vs. basal).
  
  
  CONCLUSIONS
  Irb offers no advantage over Pro in the control of portal hypertension. Moreover, its therapeutic profile is limited by important side effects.
authors.affiliation: Department of Gastroenterology, Ospedale Molinette, S. Giovanni Battista Hospital, C.so Bramante 88, 10126, Turin, Italy. wilmadebernardi@yahoo.it
authors.forename: Wilma Debernardi
authors.initials: WD
authors.lastname: Venon
authors.forename: Monica
authors.initials: M
authors.lastname: Baronio
authors.forename: Nicola
authors.initials: N
authors.lastname: Leone
authors.forename: Elio
authors.initials: E
authors.lastname: Rolfo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fadda
authors.forename: Claudio
authors.initials: C
authors.lastname: Barletti
authors.forename: Luca
authors.initials: L
authors.lastname: Todros
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saracco
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001713:Biphenyl Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology; D007022:Hypotension / Q000139:chemically induced; D000077405:Irbesartan; D007668:Kidney / Q000502:physiology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000008:administration & dosage*; D013777:Tetrazoles / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D011433:Propranolol; D000077405:Irbesartan