A study conducted by a German research group, at the University of Bonn, has examined the effects of the angiotensin II receptor antagonist irbesartan on portal and systemic hemodynamics and renal function in patients with cirrhosis.
Angiotensin II receptor antagonists have been proposed as new treatments for portal hypertension.
The randomized, double-blinded study involved 36 patients with cirrhosis and portal hypertension who received 150 mg/d irbesartan or placebo for 1 week.
Systemic hemodynamics and kidney and liver function parameters were recorded regularly.
Hepatic venous pressure gradient and plasma renin were assessed on days 0 and 7.
|Ibresartan treatment in cirrhosis:|
Hepatic venous pressure reduced by 12%.
Mean arterial pressure reduced by 5%.
Irbesartan significantly reduced hepatic venous pressure gradient by 12% and mean arterial pressure by 5% in 13 of 18 irbesartan-treated patients.
In 4 (22%) such patients, arterial hypotension, accompanied by significant renal impairment, required withdrawal of irbesartan.
Baseline plasma renin and cystatin were higher in these patients than those who tolerated irbesartan.
In addition, creatinine clearance, serum sodium, and albumin were lower than in patients successfully administered irbesartan.
Furthermore, 4 of 5 patients with baseline renin >900µU/mL developed treatment-limiting hypotension.
The research group concluded from their findings that irbesartan is not advisable in patients with advanced cirrhosis and high plasma renin, because it may induce arterial hypotension and only moderately reduces portal pressure.