Biomedical Letters

Portal Pressure Lowering Effect of Angiotensin II Receptor Antagonists in Cirrhotic Patients: A Meta-Analysis

Mounoume Lobe Irma Louise Virginie 1, Chen Hong 2

1 Medical College, Southeast University, Nanjing 210009, China

2 Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing 210009, China

Abstract

The effects of angiotensin II receptor blockers (ARBs) versus those of propranolol, a non-selective ?-blocker (NSSB), on portal hemodynamics in cirrhotic portal hypertension was investigated. Ten full text randomized controlled trials (RCTs) meeting our criteria were included in our study. Mean change of Hepatic Venous Pressure Gradient (HVPG) was considered our primary outcome. Meta-analysis was performed using revman 5.2. Ten publications were included (n=381). One study was counted twice .Five studies compared ARBs to propranolol while the others compared ARBs to placebo. Quality assessment of articles was performed using the Jadad score. Results showed that there was no difference between ARB and control group on reduction of HVPG as overall effect size is 1.04, 95%CI (-0.26, 2.33) with p value above 0.05. Analysis of heart rate(HR) showed that ARB has smaller effect on heart rate than that of placebo because overall effect size is -10.34, 95% CI (-16.64, -3.64). Analysis of effect on Wedged Hepatic Venous Pressure( WHVP) showed no difference between control and intervention group, as overall effect is 1.35 with 95%CI (-0.31, 3.01). For Mean Arterial Blood Pressure( MABP) results showed that ARB has smaller effect than that of control group, as overall effect size is -7.37 (-13.12,-1.62). Total bilirubin (Tbil) marker analysis showed that ARB has larger effect than the control group. There was no statistical significant difference between ARB and placebo groups on Cr (Creatinine). ARBs and propranolol have the same effect on HPVG and WHVP showing a reduction of portal pressure in patients with portal hypertension and cirrhosis. Hence, Angiotensin II receptor blockers can be considered as an alternative clinical approach for the treatment of portal hypertension.

Keywords: Portal hypertension, Hepatic venous pressure gradient, Randomized controlled trial, Angiotensin II receptor antagonist, Meta-analysis.

Received April 10, 2015 Revised April 30, 2015 Accepted May 12, 2015

*Correspondence: Chen Hong Email: njchenhong66@163.com.