Captopril reduces portal pressure effectively in portal hypertensive patients with low portal venous velocity

Abstract

Longterm captopril administration reduces the portal pressure effectively in cirrhotic patients with a low PVV. This suggests that the reduction in portal pressure after captopril administration is a result of improved portal venous outflow brought about by a decrease in the intrahepatic vascular resistance. When the PVV is below 12 cm/s, a captopril trial might be useful in preventing variceal bleeding in portal hypertensive patients.

Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension

“…To our knowledge, the present study is the first to formally correlate histological sub-grading of cirrhosis with clinically relevant parameters of liver function and portal hypertension. With progression to cirrhosis, the architectural distortion becomes severe and leads to an increase in intrahepatic vascular resistance and portal hypertension along with complications, such as varices and ascites [1][2][3]. In other words, the natural course of cirrhosis is characterized by the progression of portal hypertension and its complications that are responsible for significant mortality.…”

“…The distortion of architecture leads to an increase in intrahepatic vascular resistance and results in portal hypertension [1][2][3]. Therefore, with the progression to cirrhosis, portal pressure increases and severe complications, such as varices and ascites, can occur [4].…”

Renin–angiotensin–aldosterone inhibitors in the reduction of portal pressure: A systematic review and meta-analysis

“…Three trials evaluated ACEi's [39,41,42], nine trials evaluated ARB's [6,[12][13][14][43][44][45]49] and seven trials evaluated AA's [10,40,[46][47][48]50,51].…”

“…criteria but since one trial expressed HVPG results as divided by moderate and severe portal hypertension, this trial was counted twice [12], bringing the final total of included studies to nineteen [6,10,[12][13][14][39][40][41][42][43][44][45][46][47][48][49][50][51]. Three trials evaluated ACEi's [39,41,42], nine trials evaluated ARB's [6,[12][13][14][43][44][45]49] and seven trials evaluated AA's [10,40,[46][47][48]50,51].…”

Nuevos tratamientos para la infección por virus de hepatitis C y el proceso de fibrosis hepática

“…Dicha proliferación aumenta la síntesis de coláge-na I, TIMP 1 dentro de la MEC, favoreciendo el proceso de fibrosis. En estudios clínicos que la intervención con inhibidores de la enzima convertidora de angiotensina (IECA) así como los bloqueadores de sus receptores disminuyen la fibrosis hepática, mejorando a la vez la hipertensión portal secundaria [44][45] . Esta pareciera ser una estrategia que pudiera implementarse en pacientes con cirrosis hepática que ya presenten hipertensión portal independientemente de su etiología, sobre todo para evitar complicaciones como sangrado de tubo digestivo alto por ruptura de várices esofágicas.…”