Evolution of arterial hypertension in patients with hepatitis C virus cirrhosis after antiviral treatment


  • Letitia Toma Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Adriana Mercan-Stanciu Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
  • Anca Zgura Chemotherapy Department, OncoFort Hospital, Bucharest, Romania;
  • Nicolae Bacalbasa "Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Camelia Diaconu Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Romania
  • Laura Iliescu Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania University of Medicine and Pharmacy " Carol Davila", Bucharest, Romania




Arterial hypertension, Cirrhotic cardiomyopathy, HCV infection, Liver cirrhosis


Background: Chronic hepatitis C (HCV) infection has direct and indirect manifestations that promote vascular resistance. On the other hand, HCV infection leads to liver cirrhosis and complications such as cardiomyopathy, characterized by a hyperdynamic state with low peripheral vascular resistance. The aim of this paper is to study the evolution of arterial hypertension in patients with liver cirrhosis, after the cure of HCV infection.

Methods: This is a prospective observational cohort study including 261 hypertensive patients with compensated HCV cirrhosis who underwent direct-acting antiviral treatment. Blood pressure was monitored at the initiation of antiviral therapy and at 3, 6 and 12 months follow-up. Screening for cirrhosis complications was performed and patients were also monitored by electrocardiography, liver and kidney function tests, serum lipids and N-terminal pro-B-type natriuretic peptide.

Results: Virologic response after antiviral treatment led to a better control of arterial hypertension with a decrease of 24 hours mean blood pressure by 15% (p=0.04, CI 95%). In patients with stable liver disease serum levels of N-terminal pro-B-type natriuretic peptide slowly decreased at 6 and 12 months (p=0.02, p=0.03), while in patients with cirrhosis decompensation the levels increased. Also, patients with decompensated cirrhosis presented lower blood pressure values and required discontinuation of antihypertensive drugs.

Conclusions: Curing HCV infection may lead to a better control of blood pressure in patients with compensated liver disease. However, an abrupt decrease in blood pressure may be a clinical sign of progressive liver disease and cirrhotic cardiomyopathy.


NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389:37–55.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European heart J. 20181;39(33):3021-104.

Bolívar JJ. Essential hypertension: an approach to its etiology and neurogenic pathophysiology. International J Hypert. 2013;2013.

Karaca Ü, Schram MT, Houben AJ, Muris DM, Stehouwer CD. Microvascular dysfunction as a link between obesity, insulin resistance and hypertension. Diab Res Clin Pract. 2014;103(3):382-7.

Serne EH, Gans RO, ter Maaten JC, Tangelder GJ, Donker AJ, Stehouwer CD. Impaired skin capillary recruitment in essential hypertension is caused by both functional and structural capillary rarefaction. Hypertension. 2001;38(2):238-4.

European Association for The Study of The Liver. EASL recommendations on treatment of hepatitis C 2018. J Hepatol. 2018;69(2):461-511.

Cacoub P, Poynard T, Ghillani P, Charlotte F, Olivi M, Charles Piette J, Opolon P. Extrahepatic manifestations of chronic hepatitis C. Arthritis & Rheumatism: Official J Ame Coll Rheumatol. 1999;42(10):2204-12..

Iliescu L, Herlea V, Toma L, Orban C. Association between chronic HCV hepatitis, membranoproliferative glomerulopathy and cutaneous sarcoidosis. JGLD. 2015;24(1):8.

Serfaty L. Metabolic manifestations of Hepatitis C Virus. In Younossi ZM, Hepatitis C Infection as a Systemic disease: Extra-Hepatic Manifestation of Hepatitis C. Clin Liver Dis. 2017;13:475-484.

Hsu YC, Lin JT, Ho HJ, Kao YH, Huang YT, Hsiao NW, et al. Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients. Hepatology. 2014;59(4):1293-302.

European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-60.

Raevens S, De Pauw M, Geerts A, Berrevoet F, Rogiers X, Troisi RI, et al. Prevalence and outcome of diastolic dysfunction in liver transplantation recipients. Acta Cardiologica. 2014;69(3):273-80.

Izzy M, VanWagner LB, Lin G, Altieri M, Findlay JY, Oh JK, et al. Redefining cirrhotic cardiomyopathy for the modern era. Hepatology. 2020;71(1):334-45.

Toma L, Stanciu AM, Zgura A, Bacalbasa N, Diaconu C, Iliescu L. Electrocardiographic Changes in Liver Cirrhosis-Clues for Cirrhotic Cardiomyopathy. Medicina (Kaunas). 2020;56(2):68.

Iliescu L, Stanciu MA, Toma L, Dodot M, Isac T, Grumeza M. All Oral Antiviral Treatment with Paritaprevir/Ombitasvir/Ritonavir and Dasabuvir in Chronic HCV Infection Real Life Experience. Proceedings 35th Balkan Med Week. 2018: 138-143.

Gentilini P, Romanelli RG, Laffi G, Barletta G, Del Bene R, Messeri G, et al. Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture. J Hepatol. 1999;30:632-8.

LOYKE HF. Reduction of hypertension after liver disease. Arch Intern ed. 1962;110:45-9.

Henriksen JH, Moller S. Liver cirrhosis and arterial hypertension. WJG. 2006;12(5):678.

Henriksen JH, Fuglsang S, Bendtsen F, Christensen E, Møller S. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index. Am J Physiol Gastrointest Liver Physiol. 2001;280:584–94.

Chou CH, Ho CS, Tsai WC, Wang MC, Tsai YS, Chen JY. Effects of chronic hepatitis C infection on arterial stiffness. J Am Soc Hypertens. 2017;11(11):716-723.

Dalbeni A, Romano S, Bevilacqua M, Imbalzano E, Piccoli A, Mantovani A, et al. Effects of DAAs (direct-acting antivirals) on cardiac function and structure in hepatitis c (HCV) patients with low-mild liver fibrosis. Digestive Liver Disease. 2019;51:e58.

Adinolfi LE, Petta S, Fracanzani AL, Coppola C, Narciso V, Nevola R, Rinaldi L, et al. Impact of hepatitis C virus clearance by direct-acting antiviral treatment on the incidence of major cardiovascular events: A prospective multicentre study. Atherosclerosis. 2020;296:40-7.






Original Research Articles