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Portal hypertension–related complications are the major cause of morbidity and mortality in cirrhotic patients. β-blockers, such as propranolol, are currently used to lower portal pressure, but they do so by an average of only 15%. Angiotensin II–receptor antagonists, such as irbesartan, are another option, but their use is limited in cirrhotic patients because of their tendency to cause severe systemic arterial hypotension and subsequent renal failure. Now, investigators have tested the safety and efficacy of treating portal hypertension with a combination of low-dose propranolol and a very low starting dose of irbesartan.
The double-blind, placebo-controlled, 8-week trial involved 32 patients with cirrhosis who were randomized to receive p…