Angiotensin converting enzyme[ACE] inhibition versus conventional treatment of cirrhotic ascites: impact of either treatment on the renin angiotensin system

ABSTRACT

Plasma renin activity [PRA] and serum aldosterone were estimated in 10 healthy males and in 30 males with hepatic ascites before and after either angiotensin converting enzyme, ACE, inhibition by captopril 50 mg/day [n = 10], spironolactone 50 mg + Furosemide 40 mg/day [n = 10] or restriction of salt and water [n = 10]. Body weight [Wt] and abdominal girth [Gth], serum sodium, potassium and liver function tests [LFT's] were also checked before and after treatment for 3 weeks. Ascetics had higher PRA and aldosterone compared with controls [P < 0.01]. After captopril, PRA increased and aldosterone decreased [P < 0.05 and P < 0.01] with a significant decrease in Wt and Gth [P < 0.01]. After diuretics, PRA and oldosterone significantly increased [P < 0.05] with non-significant decrease in wt and Gth. Restriction of salt and water caused nonsignificant increase in PRA and a significant increase in aldosterone [P < 0.05] with non-significant increase in Wt and Gthd. Electrolytes and LFT's were not significantly affected by the 3 treatment modalities. The antiascitic effect; delta Wt and delta Gth; by captopril was significantly more than the diuretic effect [P < 0.05]. It is concluded that suppression of renin-angiotensin aldosterone system by captopril, has a significant antiascitic effect in patients with hepatic ascites. In addition, the diuretic induced hyperaldosteronism, a potential risk for failed diuresis on the long term, might be prevented by the addition of an ACE inhibition