Angiotensin II type 1 receptor blockade in early cirrhosis

Abstract

We read with great interest the article by Debernardi-Venon and collaborators, evaluating the hemodynamic response and variations in serum markers of liver fibrosis of twelve months’ administration of candesartan in Child A/B cirrhotic patients without ascites [1]. The authors found that angiotensin II type 1 receptor (AT1R) blockade induced a significant decrease in portal pressure, assessed as hepatic venous pressure gradient (HVPG), with 25% of the patients showing a decrease greater than 20%. The authors also observed a significant correlation between the reductions in HVPG and serum concentrations of hyaluronic acid. In the aforementioned study, candesartan was well tolerated in compensated cirrhotics with low plasma renin activity. The lack of severe adverse reactions was also observed in a previous report of losartan in preascitic cirrhosis [2]. In our opinion the main strength of this study is the simultaneous evaluation of hemodynamic and antifibrotic effects of AT1R blockade in humans.