title: Comparative randomized study on efficacy of losartan versus propranolol in lowering portal pressure in decompensated chronic liver disease.
abstract: OBJECTIVE
  This study aimed to compare the efficacy of losartan, an angiotensin II receptor antagonist, with propranolol on portal hypertension in patients with decompensated chronic liver disease.
  
  
  METHODS
  In all, 30 patients with Child-Pugh B cirrhosis and large varices without any prior therapy for portal hypertension were randomized to either losartan (n = 15) or propranolol (n = 15). Clinical, biochemical and hemodynamic parameters including hepatic venous pressure gradient (HVPG), wedged hepatic venous pressure (WHVP), mean arterial blood pressure (MABP) and free hepatic venous pressure (FHVP) were measured at baseline and after 4-week therapy. Patients with HVPG < 12 mmHg were regarded as responders.
  
  
  RESULTS
  An equal number of responders were seen in both groups (6/15, 40.0%). The reduction of WHVP and HVPG was greater in the losartan group than in the propranolol group, although no significant differences between them were found. Heart rate decreased more in the propranolol arm than in the losartan arm (P < 0.01); however, no correlation between the decrease of heart rate and the reduction of HVPG was observed. One patient in the losartan group, although a responder, had gastrointestinal bleeding 2 months after the drug administration, but the varices were small under endoscopy and did not require definitive therapy. The fall of MABP was greater with losartan, with no statistical difference between the two groups.
  
  
  CONCLUSIONS
  The effect of losartan was comparable to propranolol in reducing portal pressure in decompensated Child-Pugh B chronic liver disease.
authors.affiliation: Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India. anantaagasti@yahoo.in
authors.forename: Ananta Kumar
authors.initials: AK
authors.lastname: Agasti
authors.forename: Ajay U
authors.initials: AU
authors.lastname: Mahajan
authors.forename: Aniruddha Y
authors.initials: AY
authors.lastname: Phadke
authors.forename: Pratap J
authors.initials: PJ
authors.lastname: Nathani
authors.forename: Prabha
authors.initials: P
authors.lastname: Sawant
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects; D011433:Propranolol / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D011433:Propranolol; D019808:Losartan