Comparison of the Effect of Angiotensin II Receptor Antagonists Versus Beta-Blockers on the Portal Congestive Index in Cirrotics

Gastroesophageal varices are the most important portosystemic collaterals because of their propensity to rupture, constituting the most dramatic and lethal complication of cirrhosis, variceal hemorrhage, Among the various treatment modalities for portal hypertension, the medical one is the most recent and is by its nature simpler and cheaper to administer than long-term sclerotherapy or surgery. Many drugs have been evaluated in cirrhosis with portal hypertension. Many clinical trials and long-term studies have been conducted with non- selective beta-blockers, particularly propranolol. Recently, it has been suggested that the angiotensin II type 1 receptor blocker losartan can achieve a marked reduction of Hepatic venus pressure gradient in patients with cirrhosis, without significant adverse effects. The present study was done to clarify the effect of losartan on portal pressure in comparison with propranolol. Patients were divided into three groups, the control group (no treatment group), the beta-blockers group and the losartan group. The three groups were comparable regarding age, sex, results of laboratory investigations, clinical examination, ultrasonography with congestion index and endoscopic findings with no significant difference in the child score between the three groups. AS regard congestive index, there was no statistically significant difference after one week of follow-up in both losartan and control group with a p-value of (0.64). While there was a statistically significant difference after one week of treatment with a p-value of (0.006) in the propranolol group. Finally, we conclude that propranolol is effective in lowering the portal vein pressure in patients with liver cirrhosis and portal hypertension with less complication and low cost, compared with losartan which did not prove to be as effective and with more complications and consequently a higher risk of variceal haemorrhage.