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Article

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

  • Authors:
    • Jianrong Wang
    • Wenxia Lu
    • Jingjing Li
    • Rong Zhang
    • Yuqing Zhou
    • Qin Yin
    • Yuanyuan Zheng
    • Fan Wang
    • Yujing Xia
    • Kan Chen
    • Sainan Li
    • Tong Liu
    • Jie Lu
    • Yingqun Zhou
    • Chuan‑Yong Guo
  • View Affiliations / Copyright

    Affiliations: Department of Gastroenterology, Nanjing Jiangbei People's Hospital Affiliated to Nantong University, Nanjing, Jiangsu 210048, P.R. China, The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China, Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China, Department of Gastroenterology, Shanghai Tenth People's Hospital, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
  • Pages: 1977-1985
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    Published online on: March 9, 2017
       https://doi.org/10.3892/etm.2017.4210
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Abstract

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) are potential therapies for portal hypertension. Several studies have compared the renin-angiotensin-aldosterone system (RAAS) inhibitor and β‑blocker combination therapy vs. β-blocker monotherapy, with inconsistent results. The aim of the present study was to assess the efficacy of the RAAS inhibitor and β‑blocker combination therapy vs. β‑blocker monotherapy for hepatic vein pressure gradient (HVPG) reduction in cirrhosis. Studies were obtained using PubMed, Embase, Medline and Cochrane library databases up to July 2015, and the weighted mean difference (WMD) in HVPG reduction was used as a measure of treatment efficacy. In total, three studies (91 patients) were included. When compared to the β‑blocker monotherapy, the RAAS inhibitor and β‑blocker combination therapy resulted in a significant HVPG reduction [WMD 1.70; 95% confidence interval (CI): 0.52‑2.88]. However, there was no significant difference in the heart rate reduction between the monotherapy and combination therapy groups (WMD ‑0.11; 95% CI: ‑3.51‑3.29). In addition, no significant difference in the hemodynamic response was observed between the two groups (WMD 1.46; 95% CI: 0.93‑2.30). In conclusion, the RAAS inhibitor and β‑blocker combination therapy reduces portal hypertension significantly and to a greater extent than β‑blocker monotherapy. Both therapies reduced the heart rate to similar levels; however, the RAAS inhibitor and β‑blocker combination therapy reduced the mean arterial pressure to a greater extent. Due to the limited number of studies included, the data available do not allow a satisfactory comparison of adverse events. Moreover, further larger‑scale trials are required in order to strengthen the results of the present study.
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Copy and paste a formatted citation
Spandidos Publications style
Wang J, Lu W, Li J, Zhang R, Zhou Y, Yin Q, Zheng Y, Wang F, Xia Y, Chen K, Chen K, et al: Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis. Exp Ther Med 13: 1977-1985, 2017.
APA
Wang, J., Lu, W., Li, J., Zhang, R., Zhou, Y., Yin, Q. ... Guo, C. (2017). Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis. Experimental and Therapeutic Medicine, 13, 1977-1985. https://doi.org/10.3892/etm.2017.4210
MLA
Wang, J., Lu, W., Li, J., Zhang, R., Zhou, Y., Yin, Q., Zheng, Y., Wang, F., Xia, Y., Chen, K., Li, S., Liu, T., Lu, J., Zhou, Y., Guo, C."Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis". Experimental and Therapeutic Medicine 13.5 (2017): 1977-1985.
Chicago
Wang, J., Lu, W., Li, J., Zhang, R., Zhou, Y., Yin, Q., Zheng, Y., Wang, F., Xia, Y., Chen, K., Li, S., Liu, T., Lu, J., Zhou, Y., Guo, C."Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis". Experimental and Therapeutic Medicine 13, no. 5 (2017): 1977-1985. https://doi.org/10.3892/etm.2017.4210
Copy and paste a formatted citation
x
Spandidos Publications style
Wang J, Lu W, Li J, Zhang R, Zhou Y, Yin Q, Zheng Y, Wang F, Xia Y, Chen K, Chen K, et al: Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis. Exp Ther Med 13: 1977-1985, 2017.
APA
Wang, J., Lu, W., Li, J., Zhang, R., Zhou, Y., Yin, Q. ... Guo, C. (2017). Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis. Experimental and Therapeutic Medicine, 13, 1977-1985. https://doi.org/10.3892/etm.2017.4210
MLA
Wang, J., Lu, W., Li, J., Zhang, R., Zhou, Y., Yin, Q., Zheng, Y., Wang, F., Xia, Y., Chen, K., Li, S., Liu, T., Lu, J., Zhou, Y., Guo, C."Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis". Experimental and Therapeutic Medicine 13.5 (2017): 1977-1985.
Chicago
Wang, J., Lu, W., Li, J., Zhang, R., Zhou, Y., Yin, Q., Zheng, Y., Wang, F., Xia, Y., Chen, K., Li, S., Liu, T., Lu, J., Zhou, Y., Guo, C."Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis". Experimental and Therapeutic Medicine 13, no. 5 (2017): 1977-1985. https://doi.org/10.3892/etm.2017.4210
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