Background: Portal hypertension, a complication of chronic liver disease, results from elevated pressure between the portal vein and the inferior vena cava. While non-selective beta-blockers are established for reducing portal pressure, the efficacy of losartan, an angiotensin II receptor blocker, remains debated. This study evaluated losartan's impact on portal pressure and clinical outcomes in patients with cirrhosis and portal hypertension. Objectives: To appraise evidence on the role of losartan in reducing portal pressure and associated clinical outcomes in cirrhotic patients with portal hypertension. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, Medline, and Web of Science. The Risk of Bias Visualization Tool (Robvis 2.0) and ROBINS-I were used to assess study quality. Data were extracted and analyzed using Microsoft Excel. Results: Among 426 potential studies, 12 met the inclusion criteria. Both losartan and propranolol reduced hepatic venous pressure gradient (HVPG), with some studies suggesting a more pronounced effect of losartan. Meta-analysis found no significant difference in HVPG reduction (p = 0.22), but losartan significantly reduced wedged hepatic venous pressure (WHVP) compared to propranolol (p = 0.03). Losartan also affected mean arterial pressure, renal function, and hepatic fibrosis. Conclusions: Losartan shows potential in treating portal hypertension by reducing portal pressure and fibrosis. It may be particularly beneficial for patients unresponsive to beta-blockers, addressing both hemodynamic and structural components, and improving sodium handling in complex cases.

The authors have declared that no competing interests exist.

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The author(s) received no specific funding for this work.

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