HEMODYNAMIC-EFFECTS OF ENALAPRILAT ON PORTAL-HYPERTENSION IN PATIENTSWITH HBSAG-POSITIVE CIRRHOSIS

It has been suggested that enalaprilat inhibits the renin-angiotensin- aldosterone system in plasma and tissue; it may therefore reduce porta l vascular pressure owing to secondary hyperaldosteronism in patients with Liver cirrhosis. In order to evaluate this concept, 20 patients w ith hepatitis B surface antigen (HBsAg)-positive liver cirrhosis and p ortal hypertension received an intravenous infusion of 2.5 mg of enala prilat. Wedged hepatic venous pressure, free hepatic venous pressure a nd cardiac index were measured before, immediately after, and then 15 min, 30 min and 1 h after intravenous enalaprilat infusion. The mean p ressure gradient between wedged hepatic venous pressure and free hepat ic venous pressure was significantly decreased, by 13% immediately aft er, 18% at 15 min, 23% at 30 min and 13% at 1 h after infusion of enal aprilat. Thirteen patients experienced a decrease of hepatic venous pr essure gradient (HVPG) greater than 5 mmHg, another three 3-5 mmHg and the remaining four patients exhibited no significant change in HVPG. Systemic haemodynamic indices, including pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure, decrea sed significantly at 15 and 30 min after enalaprilat infusion (P < 0.0 1). Liver function, renal function and blood routine before and after enalaprilat infusion showed no significant changes. There were no adve rse effects during or after enalaprilat infusion. We conclude that ena laprilat infusion can quickly and safely reduce the hepatic venous pre ssure gradient in patients with HBsAg-positive cirrhosis.