Clinical

Angiotensin receptor blockers effective for non-alcoholic steatohepatitis

Last Updated: 2009-03-25 13:33:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Angiotensin receptor blockers are efficient in hypertension-associated non-alcoholic steatohepatitis (NASH), results of a study published in the February issue of the World Journal of Gastroenterology indicate. Telmisartan appears to be superior to valsartan with respect to insulin resistance and histology.

"Currently, non-alcoholic fatty liver disease (NAFLD) and NASH are well-recognized causes of progressive chronic liver disease leading to cirrhosis and hepatocellular carcinoma," Dr. Eugen Florin Georgescu, of Filantropia University Hospital, Craiova, Romania, and colleagues write. They note that NAFLD/NASH is seen as the hepatic component of the metabolic syndrome (MS), mediated by insulin resistance.

In a randomized, double-blind study, the researchers focused on angiotensin receptor blockers as multivalent therapeutic agents for NASH, as they target "not only hypertension but also the mechanism of insulin resistance and of hepatici injury via renin-angiotensin system as prominent pathways of liver damage."

The investigators compared the efficacy of telmisartan versus valsartan by assessing insulin resistance and NASH activity score in 54 patients (mean age 49.9 years) with NASH and mild-to-moderate hypertension. The subjects were followed for 20 months.

ALT levels decreased in both groups, with no significant difference between them.

The researchers comment that the study was not intended to take a detailed look at antihypertensive efficacy, but they "noticed that both drugs are equally potent in reducing systolic blood pressure and diastolic blood pressure."

However, telmisartan improved insulin resistance by 42.63%, compared with a 21.40% improvement with valsartan. This improvement was associated with a significant decrease of the NASH activity score and fibrosis score and an improvement of the lipid profile.

"On the other hand ... valsartan did not improve liver histology (except steatosis) and had no effect on plasma lipids," Dr. Georgescu and colleagues report.

The findings suggest that the effects of telmisartan "are driven not only through the angiotensin-1 receptor blockade, but also via its PPAR-gamma modulator specific effects," the researchers conclude.

World J Gastroenterol 2009;15:942-954.