Effect of an Angiotensin II Receptor Antagonist, Candesartan Cilexetil, on Portal Blood Flow in Liver Cirrhosis

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Previous studies have shown that angiotensin II plays a role in the regulation of hepatic sinusoidal micro-circulation, and that angiotensin II receptor antagonist decreases portal venous pressure in liver cirrhosis. We examined changes in portal blood flow using pulsed-Doppler ultrasonography before and 2 weeks after the administration of daily oral candesartan 4 mg in 12 cirrhotic patients with portal hypertension. After 2 weeks administration, maximum blood velocity of portal vein significantly (p <0.05) increased from 16.7±5.6 to 22.9±6.7 cm/s, portal blood flow volume increased to approximately 115% of basal value and the congestion index significantly (p <0.05) decreased from 0.094±0.038 to 0.063±0.033 cm·s. Plasma ammonia and ICG R<SUB>15</SUB> levels also decreased significantly (p <0.05). These results suggest that the decrease in sinusoidal resistance due to candesartan led to an increase in portal venous blood flow. Therefore, it appears likely that continuous administration of candesartan will lead to reduced, collateral blood flow and improvement of hepatic dysfunction.
The Japan Society for Portal Hypertensionの論文