Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis

摘要: β-blockers are commonly used for the treatment of acute variceal bleeding in cirrhosis. Renin-angiotensin-aldosterone antagonists (angiotensin I-converting enzyme inhibitors, angiotensin receptor blockers and aldosterone antagonists) potential therapies portal hypertension. Several studies have compared renin-angiotensin-aldosterone system (RAAS) inhibitor β-blocker combination therapy vs. monotherapy, with inconsistent results. The aim present study was to assess efficacy RAAS monotherapy hepatic vein pressure gradient (HVPG) reduction Studies were obtained using PubMed, Embase, Medline Cochrane library databases up July 2015, weighted mean difference (WMD) HVPG as a measure efficacy. In total, three (91 patients) included. When resulted significant [WMD 1.70; 95% confidence interval (CI): 0.52-2.88]. However, there no heart rate between groups (WMD -0.11; CI: -3.51-3.29). addition, hemodynamic response observed two 1.46; 0.93-2.30). conclusion, reduces hypertension significantly greater extent than monotherapy. Both reduced similar levels; however, arterial extent. Due limited number included, data available do not allow satisfactory comparison adverse events. Moreover, further larger-scale trials required order strengthen results study.