#282 Correction of portal hypertension and renal dysfunction with losartan in patients with liver cirrhosis

Abstract Background and Aims To increase the effectiveness of drug correction of portal hypertension, taking into account the functional state of patients with liver cirrhosis, using Angiotensin receptor blockers (ARBs) Method The work summarizes the results of an examination of 35 patients with liver cirrhosis (LC) who were treated in the hepatology department. The patients were divided into two subgroups: the first consisted of 21 patients with liver cirrhosis without ascites, Child-Pugh class A, and the second subgroup included 14 patients with liver cirrhosis with ascites, Child-Pugh class B. We evaluated the effect of the orally active angiotensin II receptor antagonist, losartan, on portal pressure in patients with cirrhosis and portal hypertension. Patients with (hepatic venous pressure gradient [HVPG] ≥ 13 mmHg) portal hypertension at baseline measurement were treated with an oral dose of 25 mg losartan once daily for 1 week. Results The examined patients were analyzed for the functional state of the kidneys and its relationships with the main parameters of portal hypertension and hepatic cellular failure. Comparative characteristics of the main indicators of renal function revealed significant differences in functional parameters depending on the degree of hepatic cellular failure. In the group of patients with cirrhosis with ascites, there was a significant decrease in renal GFR to 77.5 ± 1.4 ml/min, in contrast to the unchanged level of GFR in the group of patients with cirrhosis without ascites - 99.3 ml/min. However, no significant changes in serum creatinine levels were detected. Therapy with Losartan in patients with Child-Pugh class A liver cirrhosis at a dose of 25 mg/day reduces PV pressure gradient by 18.1%, at a dose of 12.5 mg/day does not significantly affect the level of portal hypertension, but improves the functional state of the kidneys (increases FPR by 56%, EPP by 17.3%). Conclusion The present study indicates that angiotensin II blockade with orally administered losartan is safe and highly effective in the treatment of portal hypertension. In patients with liver cirrhosis with the development of impaired renal reabsorption function and a decrease in FPR from 10% to 8% in the treatment of portal hypertension, the drug of choice is an ARBs (losartan 25 mg/day) with blood pressure > 115/60 mmHg.