Trial reportClinical and molecular hepatology2014
Effects of candesartan and propranolol combination therapy versus propranolol monotherapy in reducing portal hypertension.
Trial report in Clinical and molecular hepatology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Angiotensin II receptor blockers for the treatment of portal hypertension in patients with liver cirrhosis: a systematic review and meta-analysis of randomized controlled trials.Irish journal of medical science · 2018Pooled it
- Diagnostic Accuracy of Hepatic Vein Arrival Time Performed with Contrast-Enhanced Ultrasonography for Cirrhosis: A Systematic Review and Meta-Analysis.Gut and liver · 2017Pooled it
- Renin-angiotensin system inhibitors and fibrosis in chronic liver disease: a systematic review.Hepatology international · 2016Pooled it
- Rifaximin and Propranolol Combination Therapy Is More Effective than Propranolol Monotherapy for the Reduction of Portal Pressure: An Open Randomized Controlled Pilot Study.Gut and liver · 2017Trial
- From Pathophysiology to Practice: Evolving Pharmacological Therapies, Clinical Complications, and Pharmacogenetic Considerations in Portal Hypertension.Metabolites · 2025Review
- The Renin-Angiotensin System in Liver Disease.International journal of molecular sciences · 2024Review
- The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study.Hepatology international · 2021Article
- Review
- Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score.Journal of cachexia, sarcopenia and muscle · 2018Article
- Role of the renin-angiotensin system in hepatic fibrosis and portal hypertension.The Korean journal of internal medicine · 2018Review
- Novelties in the pathophysiology and management of portal hypertension: new treatments on the horizon.Hepatology international · 2018Review
- Novel treatment options for portal hypertension.Gastroenterology report · 2017Article
- Decreased potency of fimasartan in liver cirrhosis was quantified using mixed-effects analysis.Translational and clinical pharmacology · 2017Article
- In Vitro Effects of Propranolol on T Helper Type 1 Cytokine Profile in Human Leukemic T Cells.International journal of hematology-oncology and stem cell research · 2016Article
- Angiotensin receptor blocker add-on therapy in portal hypertension: to use angiotensin receptor blocker or not to use, that is the question.Clinical and molecular hepatology · 2014Article
- Propranolol: A 50-Year Historical Perspective.Annals of Indian Academy of NeurologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
aimsAngiotensin receptor blockers (ARBs) inhibit activated hepatic stellate cell contraction and are thought to reduce the dynamic portion of intrahepatic resistance. This study compared the effects of combined treatment using the ARB candesartan and propranolol versus propranolol monotherapy on portal pressure in patients with cirrhosis in a prospective, randomized controlled trial.
methodsBetween January 2008 and July 2009, 53 cirrhotic patients with clinically significant portal hypertension were randomized to receive either candesartan and propranolol combination therapy (26 patients) or propranolol monotherapy (27 patients). Before and 3 months after the administration of the planned medication, the hepatic venous pressure gradient (HVPG) was assessed in both groups. The dose of propranolol was subsequently increased from 20 mg bid until the target heart rate was reached, and the candesartan dose was fixed at 8 mg qd. The primary endpoint was the HVPG response rate; patients with an HVPG reduction of >20% of the baseline value or to <12 mmHg were defined as responders.
resultsThe mean portal pressure declined significantly in both groups, from 16 mmHg (range, 12-28 mmHg) to 13.5 mmHg (range, 6-20 mmHg) in the combination group (P<0.05), and from 17 mmHg (range, 12-27 mmHg) to 14 mmHg (range, 7-25 mmHg) in the propranolol monotherapy group (P<0.05). However, the medication-induced pressure reduction did not differ significantly between the two groups [3.5 mmHg (range, -3-11 mmHg) vs. 3 mmHg (range, -8-10 mmHg), P = 0.674]. The response rate (55.6% vs. 61.5%, P = 0.435) and the reductions in mean blood pressure or heart rate also did not differ significantly between the combination and monotherapy groups.
conclusionsThe addition of candesartan (an ARB) to propranolol confers no benefit relative to classical propranolol monotherapy for the treatment of portal hypertension, and is thus not recommended.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.