Angiotensin II receptor blockers for the treatment of portal hypertension in patients with liver cirrhosis: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Randomized controlled trials (RCTs) showed inconsistent results regarding the efficacy of angiotensin II receptor blockers (ARBs) on portal pressure as indicated by hepatic venous pressure gradient (HVPG). A meta-analysis of RCTs was performed to evaluate the influence of ARBs treatment on HVPG. PubMed, Embase, and Cochrane's Library were searched for relevant RCTs. A fixed or a randomized effect model was used to pool the results according the heterogeneity. Subgroup analyses were performed to explore the source of heterogeneity. Eleven RCTs with 394 patients were included. ARBs treatment did not significantly change HVPG as compared with controls (weighted mean difference [WMD] = -0.63, 95% confidence interval [CI] -1.73 to 0.47mmHg, p= 0.26; I2= 60%). These results were consistent in studies comparing ARBs with propranolol (WMD = -0.40, 95% CI -2.22 to 1.41mmHg, p= 0.67; I2= 68%), and those comparing ARBs with non-active controls including placebo or no treatment (WMD = -1.05, 95% CI -2.33 to 0.24mmHg, p= 0.13; I2= 44%). These results were also not affected by the individual ARBs used. Moreover, treatment of ARBs significantly reduced mean arterial blood pressure (WMD = -6.12, 95% CI -9.69 to -2.55mmHg, p= 0.008; I2= 53%), and the risk of symptomatic hypotension was increased (RR = 4.13, 95% CI 0.94 to 18.18, p= 0.06; I2= 0%). ARBs did not reduce portal pressure in patients with cirrhosis; moreover, the risk of symptomatic hypotension may increase.