[A meta-analysis of the effect and safety of angiotensin II receptor blockers in treatment of portal hypertension in cirrhotic patients].

Objective: To evaluate the efficacy and safety of the angiotensin II receptor blockers (ARB) in reducing portal hypertension (PHT) in patients with cirrhosis.

Methods: PubMed, EMBASE, Web of Science, The Cochrane Central Register of Controlled Trials, Chinese Biomedical Database, Chinese Journals Full-text Database and WanFang Digital Journal Full-text database were searched. Statistical analysis was performed by meta-analysis using RevMan4.2 software.

Results: Among 8 randomized controlled trials (RCT) including 282 patients met the inclusion criteria, 4 trials were analyzed to compare the ARB with the placebo or no treatment and the other 4 trials were analyzed to compare the ARB with propranolol. Meta-analysis results were as follows. (1)The ARB resulted in more significant hepatic venous pressure gradient (HVPG) reduction as compared with the placebo or no treatment [WMD = 1.87 mm Hg (1 mm Hg = 0.133 kPa), 95%CI (0.86 - 2.87) mm Hg, P = 0.00003]. And the ARB were similar to propranolol in reducing HVPG [WMD = 0.92 mm Hg, 95%CI (-0.41 - 2.26) mm Hg, P = 0.17]. (2)The ARB led to more significant reduction in mean arterial pressure than the placebo or no treatment [WMD = 8.89 mm Hg, 95%CI (7.16 - 10.62) mm Hg, P < 0.000 01], but they were similar to propranolol in giving rise to mean arterial pressure reduction (WMD = 0.41, 95%CI -4.46 - 5.28, P = 0.87) which had no significant difference. And the ARB had no significant effect on the heart rate of the patients, which was similar to no treatment group (P > 0.05). Whereas, propranolol could greatly decrease heart rate of the patients (WMD = -21.25, 95%CI -25.83 - 16.68, P < 0.000 01). (3) No significant differences were found in serum bilirubin and creatinine levels between the ARB and the placebo or no treatment groups (P > 0.05). The rate of nonspecific adverse events was higher in the ARB groups than in the placebo or no treatment groups (P = 0.03), but it showed there was no difference between the ARB and propranolol groups (P = 0.72).

Conclusion: The ARB is effective in reducing portal hypertension in patients with cirrhosis, which is similar to propranolol. Their effects on mean arterial pressure is similar to propranolol without significant effects on hear rate, liver function and kidney function, and with less nonspecific adverse events. The ARB could become a new choice for the treatment of portal hypertension.