Effects of long-term Irbesartan in reducing portal pressure in cirrhotic patients: comparison with propranolol in a randomised controlled study

Background/Aims: The role of angiotensin II (AT-II) type I receptor antagonists in the treatment of portal hypertension remains controversial. We tested the efficacy of Irbesartan (Irb) vs. Propranolol (Pro) in reducing portal pressure and evaluated its systemic haemodynamic effects. Methods: Thirty-four patients were randomly assigned to receive either Irb 300 mg/day (19 patients) or Pro 40–120 mg/day (15 patients) for 2 months. Results: Irb was discontinued in five patients (26%). No major side effect occurred in the Pro group. On an average, the portal pressure gradient decreased significantly more in the Pro than in the Irb group (median −19.5%, range −11/−31% vs. −4.8%, +2.5/−10%, P<0.001). A clinically significant decrease was seen in one (7%) of the patients given Irb vs. five (33%) given Pro (P<0.02). The fall in mean arterial pressure was significantly higher with Irb than with Pro (median −29%, range −15/−45% vs. −4.9%, +8/−19%, P<0.02). Irb significantly modified the blood creatinine clearance (median −29 ml/m, range +9/−61 ml/m, −30, −24/−35% P<0.0001 vs. basal). Conclusions: Irb offers no advantage over Pro in the control of portal hypertension. Moreover, its therapeutic profile is limited by important side effects.