Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 28, 2009; 15(8): 942-954
Published online Feb 28, 2009. doi: 10.3748/wjg.15.942
Angiotensin-receptor blockers as therapy for mild-to-moderate hypertension-associated non-alcoholic steatohepatitis
Eugen Florin Georgescu, Reanina Ionescu, Mihaela Niculescu, Laurentiu Mogoanta, Liliana Vancica
Eugen Florin Georgescu, Reanina Ionescu, Liliana Vancica, Department of Internal Medicine 2, Filantropia University Hospital, Str. Constantin Brancusi nr. 3, Craiova 200136, Romania
Eugen Florin Georgescu, Reanina Ionescu, Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Str.Petru Rares 4, Craiova 200349, Romania
Mihaela Niculescu, Laurentiu Mogoanta, Department of Pathology, University of Medicine and Pharmacy of Craiova, Str.Petru Rares 4, Craiova 200349, Romania
Mihaela Niculescu, Department of Pathology, Filantropia University Hospital, Str. Constantin Brancusi nr. 3, Craiova 200136, Romania
Author contributions: Georgescu EF conducted the trial, designed the study flowchart, analyzed the data and wrote the manuscript; Ionescu R participated in treating patients; Niculescu M performed the histology study; Mogoanta L supervised the histology database and the randomization procedure and analyzed data; Vancica L participated in treating patients, collecting the data and operating the database.
Correspondence to: Eugen Florin Georgescu, Professor, Department of Internal Medicine 2, Filantropia University Hospital, Str. Constantin Brancusi nr. 3, Craiova 200136, Romania. efg@usa.net
Telephone: +40-374-011671  
Fax: +40-251-420896
Received: September 10, 2008
Revised: January 9, 2009
Accepted: January 16, 2009
Published online: February 28, 2009
Abstract

AIM: To evaluate insulin resistance, cytolysis and non-alcoholic steatohepatitis (NASH) score (NAS) using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension, treated with telmisartan vs valsartan for 20 mo.

METHODS: All patients met the NCEP-ATP III criteria for metabolic syndrome. Histology confirmed steatohepatitis, defined as a NAS greater than five up to 3 wk prior inclusion, using the current criteria. Patients with viral hepatitis, chronic alcohol intake, drug abuse or other significant immune or metabolic hepatic pathology were excluded. Subjects were randomly assigned either to the valsartan (V) group (standard dose 80 mg o.d., n = 26), or to the telmisartan (T) group (standard dose 20 mg o.d., n = 28). Treatment had to be taken daily at the same hour with no concomitant medication or alcohol consumption allowed. Neither the patient nor the medical staff was aware of treatment group allocation. Paired liver biopsies obtained at inclusion (visit 1) and end of treatment (EOT) were assessed by a single blinded pathologist, not aware of patient or treatment group. Blood pressure, BMI, ALT, AST, HOMA-IR, plasma triglycerides (TG) and total cholesterol (TC) were evaluated at inclusion and every 4 mo until EOT (visit 6).

RESULTS: At EOT we noticed a significant decrease in ALT levels vs inclusion in all patients and this decrease did not differ significantly in group T vs group V. HOMA-IR significantly decreased at EOT vs inclusion in all patients but in group T, the mean HOMA-IR decrease per month was higher than in group V. NAS significantly diminished at EOT in all patients with a higher decrease in group T vs group V.

CONCLUSION: Angiotensin receptor blockers seem to be efficient in hypertension-associated NASH. Telmisartan showed a higher efficacy regarding insulin resistance and histology, perhaps because of its specific PPAR-gamma ligand effect.

Keywords: Telmisartan, Valsartan, Non-alcoholic steatohepatitis, Hypertension, Insulin-resistance, Hepatic steatosis, Necroinflammation