Background: Angiotensin II (A-II) is considered a potential mediator of intrahepatic portal hypertension because its plasma level is elevated in cirrhotic patients. Valsartan-A II blocker- is being tested for use as a portal pressure reducing drug.
Aim: To compare haemodynamic changes of 1 week and 1 month treatment with valsartan versus propranolol in cirrhotic portal hypertensive patients.
Patients and Methods: Thirty-five males and 16 females with liver cirrhosis and portal hypertension were included. Twenty-six received valsartan 80 mg orally and 25 received propranolol 40 mg daily orally. Serum K+, Na+, renin and aldosterone levels before and after 1 week therapy were recorded. Systemic and hepatic hemodynamics were assessed before, after 1 week and 1 month of treatment using colour Doppler sonography.
Results: A significant reduction in aldosterone and increase in the plasma renin activity were recorded in valsartan group. Heart rate showed significant reduction in propranolol group. While, significant reduction in mean arterial pressure in valsartan group was noticed at the end of 1 week and 1 month treatment. A significant reduction in the portal vein diameter, portal vein velocity and portal vein flow volume was observed more after 1 month than after 1 week treatment in both groups. Patients with Child C showed more hypotensive effect of valsartan than those with Child A or B, so therapy with this drug is not recommended in those patients.
Conclusion: Valsartan can be a good alternative to propranolol in reducing portal hypertension in child A and B liver cirrhosis especially those with large varices. Further studies are needed to assess the long-term effect of valsartan in those patients.