Impact of Losartan on Portal hypertension and Liver Cirrhosis: A Systematic Review

Abstract Background Portal hypertension, a complication of chronic liver disease, results from elevated pressure between the portal vein and the inferior vena cava. While non-selective beta-blockers are established for reducing portal pressure, the efficacy of losartan, an angiotensin II receptor blocker, remains debated. This study evaluated losartan’s impact on portal pressure and clinical outcomes in patients with cirrhosis and portal hypertension. Objectives To appraise evidence on the role of losartan in reducing portal pressure and associated clinical outcomes in cirrhotic patients with portal hypertension. Methods A comprehensive literature search was conducted in PubMed, Cochrane Library, Medline, and Web of Science. All the research and review of literature was conducted within the time period from August 20th, 2024 till August 31st, 2024 (within 1 month of submission of the paper). The Risk of Bias Visualization Tool (Robvis 2.0) and ROBINS-I were used to assess study quality. Data was extracted and analyzed using Microsoft Excel. Results Among 426 potential studies, 12 met the inclusion criteria. Both losartan and propranolol reduced hepatic venous pressure gradient (HVPG), with some studies suggesting a more pronounced effect of losartan. Meta-analysis found no significant difference in HVPG reduction (p = 0.22), but losartan significantly reduced wedged hepatic venous pressure (WHVP) compared to propranolol (p = 0.03). Losartan also affected mean arterial pressure, renal function, and hepatic fibrosis. Conclusions Losartan shows potential in treating portal hypertension by reducing portal pressure and fibrosis. It may be particularly beneficial for patients unresponsive to beta-blockers, addressing both hemodynamic and structural components, and improving sodium handling in complex cases.