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

  • Published online on: March 9, 2017     https://doi.org/10.3892/etm.2017.4210
  • Pages: 1977-1985
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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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May-2017
Volume 13 Issue 5

Print ISSN: 1792-0981
Online ISSN:1792-1015

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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