PORTAL HYPERTENSION TREATMENT WITH CANDESARTAN PLUS PROPRANOLOL FOR NINE MONTHS RESTORES NORMAL PORTAL CIRCULATION HEMODYNAMIC PATTERN

ABD ALLA, MOHAMED D.; EID, EL-SAYED M. M.; SOLIMAN, ALI I. A.; ELHAWARY, MOSTAFA A.; KILANY, YASSER F.; ABD-ALMONAEM, GADAH; BAYOUMI, SAMEH S.; MOURSY, MOHAMED R. A.; AL-ZAEM, FARES A. M.

doi:10.21608/jesp.2016.88263

	PORTAL HYPERTENSION TREATMENT WITH CANDESARTAN PLUS PROPRANOLOL FOR NINE MONTHS RESTORES NORMAL PORTAL CIRCULATION HEMODYNAMIC PATTERN
Journal of the Egyptian Society of Parasitology
Article 16, Volume 46, Issue 3, December 2016, Page 587-604 PDF (487.52 K)
Document Type: Original Article
DOI: 10.21608/jesp.2016.88263
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Authors
MOHAMED D. ABD ALLA¹; EL-SAYED M. M. EID¹; ALI I. A. SOLIMAN¹; MOSTAFA A. ELHAWARY¹; YASSER F. KILANY¹; GADAH ABD-ALMONAEM²; SAMEH S. BAYOUMI³; MOHAMED R. A. MOURSY⁴; FARES A. M. AL-ZAEM⁵
¹Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Egypt
²Department of Radiology, Faculty of Medicine, Al-Zagazig University, Egypt
³Department of Radiology, Faculty of Medicine, Al-Zagazig University, Egypt.
⁴Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Egypt
⁵Department of Medicine, Hepatology ICU Division, Hhia Central Hospital
Abstract
Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow (PVF) and intrahepatic resistances (IHR). PVF is partially controlled by using both specific and non-specific beta blockers (NSBBs) that have insignificant effects on IHR. Angiotensin receptor blockers (ARBs) inhibit the activated hepatic stellate cell (HSC) contraction and thought to reduce the dynamic portion of IHR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension (PH). Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices (OV), were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index (DI), pulse Pulsatility Index (PI), Portal Venous Flow (PVF) Volume, Portal Venous Peak Velocity (PVPV), and Portal Vein Diameter (PVD) were evaluated once every third month. Our study concluded that combined therapy (Propranolol + Candesartan) induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume & PVPV overtime compared to monotherapy regimens (P>0.001). Data strongly recommended using Propranolol plus Candesartan in overtime management of portal hypertension.
Keywords
Portal-vein; hemodynamics; NSBBs; ARBs; Combined therapy


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