[Is it possible to predict a decrease in portal pressure after administration of ACE inhibitors?]

We have previously shown that angiotensin converting enzyme inhibitor enalapril causes a potent decrease in portal pressure gradient, but only in about one half of patients with portal hypertension and an episode of bleeding esophageal varices in patient's history. Twenty-one consecutive patients after first episode of bleeding from esophageal varices were enrolled in the trial. Patients were treated by sclerotherapy in combination with enalapril. The level of ACE in patients with portal hypertension (10.4, SD 4.5) was significantly higher than in normal population (4.5, SD 1.3 mu kat/l-1) [p < 0.001]. After 3 months treatment decreased ACE to normal or subnormal levels in all 21 patients (2.9, SD 1.5 mu kat.l-1) [p < 0.001], but simultaneously measured hepatic venous pressure gradient decreased more than 3 mm Hg only in 11 (52%). No correlation between changes of portal pressure gradient and changes of ACE concentrations were found. We conclude that patients with portal hypertension have significantly higher serum ACE level with a large decrease after enalapril, but it is not possible to predict the effect of enalapril on portal pressure by estimation of ACE level in serum in individual patient.