Lisinopril liver
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Lisinopril and Liver Health: A Comprehensive Overview
Introduction to Lisinopril and Liver Health
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to manage hypertension and heart failure. However, its effects on liver health have been a subject of various studies, revealing both beneficial and adverse outcomes. This article synthesizes the current research on the impact of lisinopril on liver health, focusing on its hemodynamic effects, potential hepatotoxicity, and its role in liver regeneration and fibrosis.
Hemodynamic Effects of Lisinopril in Liver Transplant Patients
Lisinopril has been shown to effectively manage hypertension in liver transplant recipients. A study comparing the effects of amlodipine, bisoprolol, and lisinopril found that lisinopril significantly reduced systolic blood pressure (SBP) and the augmentation index (AIx), a measure of arterial wave reflection. This indicates that lisinopril not only lowers peripheral SBP but also reduces central aortic pressure, making it a preferred choice over bisoprolol for these patients 1.
Lisinopril and Liver Toxicity
Case Reports of Hepatotoxicity
Despite its benefits, lisinopril has been associated with hepatotoxicity in some cases. A notable case involved a 30-year-old woman who developed hepatocellular disease after eight months of lisinopril therapy. Her condition improved rapidly after discontinuing the drug, suggesting a direct link between lisinopril and liver injury 3. Another report described a 59-year-old woman who developed fulminant hepatic cholestasis after starting lisinopril, which unfortunately led to her death despite discontinuation of the drug 4. These cases highlight the potential for severe liver injury, albeit rare, associated with lisinopril use.
Experimental Studies on Hepatotoxicity
Animal studies have also explored lisinopril's impact on liver health. In a study using a rat model of L-NAME-induced hypertension, lisinopril treatment led to significant hepatocyte degeneration and elevated serum enzyme levels, indicating liver damage 2. These findings suggest that while lisinopril is effective in managing hypertension, it may pose risks to liver health under certain conditions.
Lisinopril in Liver Regeneration and Fibrosis
Enhancing Liver Regeneration
Interestingly, lisinopril has shown promise in enhancing liver regeneration. Research on rats undergoing partial hepatectomy demonstrated that lisinopril significantly increased liver regeneration rates, likely due to its inhibition of ACE and subsequent increase in bradykinin levels, which are known to promote liver growth 8. This suggests a potential therapeutic role for lisinopril in conditions requiring enhanced liver regeneration.
Anti-Fibrotic Effects
Lisinopril has also been studied for its anti-fibrotic properties. In a mouse model of bile duct ligation-induced liver fibrosis, lisinopril treatment resulted in reduced serum markers of fibrosis and improved liver histology 9. Additionally, combining lisinopril with silymarin, a known anti-fibrotic agent, further enhanced its anti-inflammatory and anti-fibrotic effects, suggesting a synergistic potential for treating liver fibrosis 6.
Conclusion
Lisinopril presents a complex profile regarding liver health. While it effectively manages hypertension and can enhance liver regeneration and reduce fibrosis, it also carries a risk of hepatotoxicity in certain individuals. Clinicians should weigh these benefits and risks when prescribing lisinopril, particularly in patients with pre-existing liver conditions. Further research is needed to fully understand the mechanisms behind lisinopril-induced liver injury and to identify patients at risk.
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Most relevant research papers on this topic
Hemodynamic effects of amlodipine, bisoprolol, and lisinopril in hypertensive patients after liver transplantation1
Lisinopril is the preferred treatment for hypertension after liver transplantation, as it reduces augmentation index and systolic blood pressure more effectively than bisoprolol.
RCTEffect of lisinopril on rat liver tissues in L-NAME induced hypertension model
Lisinopril treatment effectively reduces blood pressure in L-NAME-induced hypertension models, but may cause hepatocyte degeneration, serum enzyme elevation, and slight mononuclear cell infiltration.
RCT
Animal StudyUnique case of presumed lisinopril-induced hepatotoxicity.
Lisinopril-induced hepatotoxicity resolved after discontinuing the drug in a 30-year-old woman with no history of liver-related issues.
Case ReportLisinopril-Induced Liver Injury: An Unusual Presentation and Literature Review
Lisinopril-induced liver injury can present as hepatocellular or cholestatic injury, and severe hepatotoxicity secondary to lisinopril can be life-threatening, regardless of the injury pattern.
Case ReportFulminant hepatitis after lisinopril administration.
Lisinopril may induce acute hepatitis, and continuing treatment after onset of jaundice can lead to life-threatening hepatic failure.
Case ReportLisinopril inhibits nuclear transcription factor kappa B and augments sensitivity to silymarin in experimental liver fibrosis
Lisinopril and silymarin combination effectively reduces liver fibrosis by targeting the NF&kgr;B pathway, improving liver function and oxidative stress markers.
Non-RCTAnimal Study
Rigorous JournalPP.07.35: EFFECTS OF LISINOPRIL/AMLODIPINE SINGLE PILL COMBINATION ON AMBULATORY BRACHIAL AND CENTRAL BLOOD PRESSURE IN HYPERTENSIVE SUBJECTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Lisinopril/amlodipine fixed combination effectively reduces ambulatory brachial and central blood pressure in hypertensive patients with non-alcoholic fatty liver disease, improving arterial stiffness.
Rigorous JournalAngiotensin-converting enzyme inhibition by lisinopril enhances liver regeneration in rats.
Lisinopril inhibition enhances liver regeneration after partial hepatectomy in rats, potentially explaining its growth-stimulating effect.
Non-RCTAnimal StudyInhibitory effects of lisinopril on obstructive cholestasis induced liver fibrosis in mice
Lisinopril effectively prevents hepatic fibrosis in mice models with bile duct ligation-induced biliary cholestasis.
RCTAnimal StudyEffect of Angiotensin-Converting Enzyme Inhibitor, Lisinopril on Morphological and Biochemical Aspects of Fibrotic Liver Regeneration
Lisinopril does not significantly alter liver regeneration after partial hepatectomy, but may improve its functional capability.
Non-RCTAnimal StudyRigorous Journal