| Objective: The study observed the effects of enalapril, an angiotensin converting enzyme inhibitor, on hemadynamics in patients with portal hypertension, and on values of plasma renin activity angiotensinⅡldosterone including the changes in the liver and renal function tests, blood pressure, the heart rate. The aim is to evaluate the effects of enalapril on portal pressure and its safety to the clinical medication.Methods: The study was performed in 32 patients with portal hypertension. The Child-Pugh score was A in 6 patients, B in 13 patients, and C in 13. Two patients were alcoholics, 26 had HBV-related and 3 HCV-related cirrhoses, and 1 had biliary cirrhosis. Two patients discontinued treatment because blood pressures were less than90/60mmHg about three days after treatment. The diameters and average velocities of portal were examined in 30 normal people. These patients received enalapril (5mg, 2 times per day) as well as the routine treatment. The diameters and average velocities of portal and splenic veins were measured at before and after therapy 1, 2, 3,4 weeks respectively. The plasmarennin activity, angiotensin, aldosterone, liver function and renal function tests were performed while starting and stopping observation. The blood pressure and heart rate were determined at 8:00,12:00,16:00 20:00per day. American HP5500 ultrasound instrument was used to determine the diameters and average velocities of portal vein and splenic vein. The examination was taken in morning in fasting quietly. The same technician performed these operations. The plasma rennin activity, angiotensin, aldosterone were determined by radioimmunoassays. The liver and renal function tests were determined by Olympud Au 2700 auto-biochemistry analysis instrument. Blood routine examination was taken by Coulter micro Diff auto-hemocyte analysis instrument. Results are expressed as mean±SEM and the statistical analysis was performed using the paired Student's t-test. Results were considered statistically significant at P<0.05.Results: 1. Enalapril reduced the portal venous average diameter by 5.3% (P>0.05) at 1 week and by 13.9%,15.3%,15.3% (P<0.05) at 2,3,4 weeks, and there were no significant difference among 2,3,4 weeks(P>0.05). The average velocity of portal vein decreased 10.1% at 1week and 20.6%,23.3%,23.2% at 2,3,4weeks (P<0.01), but there were no significant difference among 2,3,4 weeks(P>0.05). The average portal venous flow significantly decreased at 1 week 21.3% (P<0.01), 42.0%,43.3%,43.1% at 2,3,4 weeks (P<0.001),but there were no significant difference among 2,3,4 weeks(P>0.05). Enalapril reduced the average splenic venous diameter 7.7% at 1 week (P>0.05), 16.2%,17.9%,17.9% (P<0.05) at 2, 3,4 weeks. There were no significant differences among 2, 3 and 4 weeks (P>0.05). The average velocity of splenic vein significantly decreased 6.9%at 1 week, 15.4%,16.3%,16.2% at 2,3,4 weeks (P<0.05), but there were no significant difference among 2,3,4 weeks (P>0.05). The average splenic venous flow significantly decreased 19.8% at 1 week (P<0.01), 39.6%,40.5%,40.5% at 2,3,4 weeks (P<0.001), but there were no significant difference among 2,3,4 weeks (P>0.05). The portal venous flows in patients were still more than in normal people after treatment.2. The changes of plasma rennin activity, angiotensin and aldosterone: After treatment, the average value of rennin increased from 3.46±2.40ng/mL.24h to 6.89±1.34ng/mL.24h (P<0.001). The average value of angiotensin decreased from 48.72±36.60pg/mL to 29.34±22.33pg/mL (P<0.001). The average value of aldosterone decreased from 192.28±62.73pg/mL to 89.5±48.63pg/mL (P<0.001). 3.There were some changes before and after treatment in the liver function tests.Total bilirubin decreased from 117.63±86.13 umol/L to 74.14±43.61umol/L(P<0.05),and there were no significant differences in serum albumin and prothrombin time(P>0.05).4. The renal funtion tests of patients decreased slightly after treatment. The average value of BUN decreased...
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