Schepke, Michael and Wiest, Reiner and Flacke, Sebastian and Heller, Joerg and Stoffel-Wagner, Birgit and Herold, Thomas and Ghauri, Masooma and Sauerbruch, Tilman (2008) Irbesartan plus low-dose propranolol Versus low-dose propranolol alone in cirrhosis: A placebo-controlled, double-blind study. AMERICAN JOURNAL OF GASTROENTEROLOGY, 103 (5). pp. 1152-1158. ISSN 0002-9270,
Full text not available from this repository.Abstract
OBJECTIVES: Angiotensin II receptor antagonists have been shown to moderately lower portal pressure in some patients with cirrhosis but may have adverse effects on kidney function. This study aimed at comparing the effects of a combined treatment using irbesartan plus propranolol with propranolol monotherapy on portal pressure and kidney function in patients with cirrhosis. METHODS: Thirty-two patients were included (Child A/B/C: 13/18/1, etiology: 16 alcohol, 13 viral, 3 other; bilirubin 1.4 +/- 1.1 mg/dL, creatinine 0.86 +/- 0.20 mg/dL, baseline hepatic venous pressure gradient 18.7 +/- 5.3 mmHg). All patients received 20 mg propranolol b.i.d. Additionally, they randomly received either placebo (N = 15) or irbesartan (step-up dosage titration up to 300 mg/d, N = 17). Patients were followed at weekly intervals, re-evaluation of hepatic venous pressure gradient (HVPG) was performed after 8 wk. RESULTS: One patient in the propranolol/irbesartan group was excluded due to variceal bleeding. No other adverse events occurred. Portal pressure declined in both groups (propranolol/irbesartan group 19.6 +/- 1.5 mmHg to 16.6 +/- 1.2 mmHg, P=0.037, propranolol/placebo group 17.8 +/- 1.1 mmHg to 15.1 +/- 1.2 mmHg, P = 0.019). Sodium excretion significantly increased in the propranolol/irbesartan group (from 122 +/- 20 mmol/d to 230 +/- 23 mmol/d, P=0.045), but not in the propranolol/placebo group. CONCLUSIONS: Combination treatment of propranolol plus irbesartan is well tolerated in cirrhotic patients when titrating the angiotensin II antagonist in a step-up manner, and it increases sodium excretion in patients with compensated or moderately decompensated cirrhosis. Addition of irbesartan has no effect on portal pressure.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | II RECEPTOR ANTAGONIST; PORTAL PRESSURE RESPONSE; PREASCITIC CIRRHOSIS; VARICEAL HEMORRHAGE; VENOUS-PRESSURE; LIVER FIBROSIS; HEPATITIS-C; LOSARTAN; HYPERTENSION; PREVENTION; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin I Medicine > Lehrstuhl für Röntgendiagnostik |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 03 Nov 2020 06:41 |
| Last Modified: | 03 Nov 2020 06:41 |
| URI: | https://pred.uni-regensburg.de/id/eprint/30913 |
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