[The ACE inhibitor, enalapril, in portal hypertension. A prospective placebo controlled study].

The haemodynamic action of long-term (3 months) therapy with enalapril, a potent inhibitor of angiotensin convertase was investigated in 12 patients selected at random, all suffering from portal hypertension and a previous episode of haemorrhage from oesophageal varices. In all these patients after one-week intervals sclerotization of oesophageal varices was made. As controls served a group of 13 patients treated only by sclerotherapy and placebo. In the enalapril treated group after three months the pressure in the wedged hepatic vein (25 +/- 4.8 vs. 21.3 4.8 mm Hg) and the pressure gradient wedged free hepatic vein (17.0 +/- 6.0 vs. 12.6 +/- 3.4 mm Hg) were significantly lower than the initial values (p less than less than 0.01) in the enalapril treated group. A very marked decline (greater than 3 mm Hg) of this pressure was recorded in 50% of the patients. In the group treated by sclerotherapy and placebo the pressure gradient did not decline. During treatment no changes in the systemic haemodynamics and liver tests occurred. None of the patients died during the investigation and the subsequent 6-month period. The authors provided evidence that enalapril reduces the portal pressure in patients with hypertension, although not in all, and can be successfully used for the treatment of patients with oesophageal varices in combination with sclerotherapy.