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[The ACE inhibitor, enalapril, in portal hypertension. A prospective placebo controlled study]
P Svoboda1, J Ochmann, I Kantorová
1Výzkumný ústav traumatologie a speciální chirurgie, Brno.
Insights
Enalapril, an angiotensin-converting enzyme inhibitor, significantly reduced portal pressure in patients with portal hypertension and esophageal varices when combined with sclerotherapy. This therapy offers a potential treatment option for managing this condition.
Area of Science:
- Gastroenterology
- Cardiology
- Pharmacology
Background:
- Portal hypertension is a serious condition often leading to esophageal varices and hemorrhage.
- Current treatments for portal hypertension and esophageal varices have limitations.
Purpose of the Study:
- To investigate the hemodynamic effects of long-term enalapril therapy in patients with portal hypertension and a history of esophageal variceal hemorrhage.
- To evaluate enalapril's efficacy as an adjunct to sclerotherapy for managing esophageal varices.
Main Methods:
- A randomized study involving 12 patients treated with enalapril and sclerotherapy, compared to 13 control patients receiving sclerotherapy and placebo.
- Hemodynamic parameters, including wedged hepatic vein pressure and hepatic venous pressure gradient, were measured over three months.
- Systemic hemodynamics and liver function tests were monitored throughout the study.
Main Results:
- Enalapril treatment significantly reduced both wedged hepatic vein pressure and hepatic venous pressure gradient compared to baseline values (p<0.01).
- A marked decline (>3 mm Hg) in portal pressure was observed in 50% of patients receiving enalapril.
- No significant changes in systemic hemodynamics or liver tests were noted during enalapril therapy.
- The control group (sclerotherapy and placebo) showed no decline in portal pressure gradient.
Conclusions:
- Enalapril effectively reduces portal pressure in a significant portion of patients with portal hypertension.
- Enalapril can be safely and successfully used in combination with sclerotherapy for treating patients with esophageal varices.
- The study provides evidence for enalapril's role in managing portal hypertension complications.
Abstract:
The haemodynamic action of long-term (3 months) therapy with enalapril, a potent inhibitor of angiotensin convertase was investigated in 12 patients selected at random, all suffering from portal hypertension and a previous episode of haemorrhage from oesophageal varices. In all these patients after one-week intervals sclerotization of oesophageal varices was made. As controls served a group of 13 patients treated only by sclerotherapy and placebo. In the enalapril treated group after three months the pressure in the wedged hepatic vein (25 +/- 4.8 vs. 21.3 4.8 mm Hg) and the pressure gradient wedged free hepatic vein (17.0 +/- 6.0 vs. 12.6 +/- 3.4 mm Hg) were significantly lower than the initial values (p less than less than 0.01) in the enalapril treated group. A very marked decline (greater than 3 mm Hg) of this pressure was recorded in 50% of the patients. In the group treated by sclerotherapy and placebo the pressure gradient did not decline. During treatment no changes in the systemic haemodynamics and liver tests occurred. None of the patients died during the investigation and the subsequent 6-month period. The authors provided evidence that enalapril reduces the portal pressure in patients with hypertension, although not in all, and can be successfully used for the treatment of patients with oesophageal varices in combination with sclerotherapy.