Hemodynamic effects of the angiotensin II receptor antagonist irbesartan in patients with cirrhosis and portal hypertension

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

“…76 ISMN, a potent venodilator, may lead to a higher mortality in these patients by aggravating the vasodilatory state of the cirrhotic patient, 77 as shown in shorter-term hemodynamic trials using other vasodilators such as losartan 78 and irbesartan. 79 In fact, in a recent multicenter trial, 133 cirrhotic patients with varices and contraindications or intolerance to ␤-blockers were randomized to ISMN (n ϭ 67) or to placebo (n ϭ 66). 80 Surprisingly, there was a greater 1-and 2-year probability of first variceal hemorrhage in the ISMN group (p ϭ 0.056), with no differences in survival.…”

Heart Function and Myocardial Tissue Characterization in Patients with HCV Related Cirrhosis: Diastolic Dysfunction and Cardiac Hypertrophy

“…These findings also introduce new considerations on the potential role of drugs such as beta blockers, angiotensin II receptor antagonists and aldosterone antagonists: their therapeutic application in earlier stages of the cirrhotic disease might prove useful in the clinical management of cirrhotic cardiomyopathy before decompensation of disease develops [63][64][65].…”

Vascular mediators in the injured liver

“…Given data indicating that angiotensin II induces stellate cell (and smooth muscle cell) contractility, the RAAS is an attractive therapeutic target in intrahepatic portal hypertension. However, studies in humans with cirrhosis in which angiotensin II signaling has been blocked have been met with mixed results [83][84][85] ; in particular, angiotensin II receptor antagonists adversely affected glomerular filtration rate and caused systemic hypotension in cirrhotic patients 85 ; therefore, caution is required with these agents. Indeed, because of potential systemic adverse effects, some have suggested that cirrhotic patients not be treated with these compounds.…”