title: Captopril reduces portal pressure effectively in portal hypertensive patients with low portal venous velocity.
abstract: BACKGROUND
  The effect of an angiotensin II blockade in lowering the portal pressure in patients with liver cirrhosis and portal hypertension is controversial. This prospective study was undertaken to evaluate the portal hypotensive effect of captopril compared to that of propranolol, and to determine the factors that contribute to a successful reduction in the portal pressure after longterm captopril administration in patients with liver cirrhosis.
  
  
  METHODS
  The hepatic venous pressure gradient (HVPG) and portal venous velocity (PVV) were measured both before and 3 months after initiation of the administration of captopril (n = 29) or propranolol (n = 29) in cirrhotic patients with a variceal bleeding episode. Patients who showed a reduction in the HVPG of more than 20% of the baseline were defined as being responders.
  
  
  RESULTS
  At 3 months, the mean reduction in the HVPG after captopril was less than that after propranolol (-3.0 +/- 9.3% vs -28.5% +/- 4.1%; P < 0.05). However, of the 29 patients receiving captopril, 9 were classified as being responders. On multivariate analysis with parameters including age, cause, Child-Pugh score, HVPG, and PVV, only low PVV was found to be a significant independent factor for responders (PVV < 12 cm/s; odds ratio [OR], 12.2; 95% confidence interval [CI], 1.47-102.40) in the captopril group.
  
  
  CONCLUSIONS
  Longterm captopril administration reduces the portal pressure effectively in cirrhotic patients with a low PVV. This suggests that the reduction in portal pressure after captopril administration is a result of improved portal venous outflow brought about by a decrease in the intrahepatic vascular resistance. When the PVV is below 12 cm/s, a captopril trial might be useful in preventing variceal bleeding in portal hypertensive patients.
authors.affiliation: Department of Internal Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, 162 Ilsan-Dong, 220-701 Wonju, South Korea.
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Dong Hun
authors.initials: DH
authors.lastname: Park
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Yeun Jong
authors.initials: YJ
authors.lastname: Choi
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Joong Wha
authors.initials: JW
authors.lastname: Park
authors.forename: Sei Jin
authors.initials: SJ
authors.lastname: Chang
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001783:Blood Flow Velocity / Q000502:physiology; D002216:Captopril / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects*; D011169:Portal Vein / Q000503:physiopathology; D011433:Propranolol / Q000008:administration & dosage*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002216:Captopril; D011433:Propranolol