***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Summary Background Recent data suggest that the renin-angiotensin-aldosteron system ( RAAS ) may be of importance in the pathogenesis of nonalcoholic fatty liver disease ( NAFLD ) . We were interested to investigate whether the therapy with RAAS blockers in patients with different stages of chronic kidney disease ( CKD ) has any effect on steatosis and fibrosis grade ; NAFLD documented by transient elastography ( TE ) ( Fibroscan ® -CAP ) . Methods Of 191 patients with various stages of CKD there were 61 patients with CKD grade III and IV , 62 patients with end-stage renal disease treated with chronic hemodialysis and 68 renal transplant recipients .  Liver stiffness was selected as the parameter to quantify liver fibrosis . Furthermore , the Controlled Attenuation Parameter ( CAP ) was used to detect and quantify liver steatosis with the help of TE . Results CKD patients ( p = 0.005 ) and CKD-NAFLD patients ( p = 0.0005 ) with angiotensin-converting enzyme inhibitors ( ACE-I ) or angiotensin receptor blockers ( ARBs ) had statistically significant lower degree of liver stiffness in comparison to those without these medications ( p = 0.005 ) . Also , we were interested to explore is there any difference in fibrosis and steatosis grade due to use of ACE-I or ARBs . We did not find statistically significant differences between those two subgroups of patients with respect to liver steatosis/fibrosis . Conclusion Based on our results , RAAS blockers could be an attractive option for the management of NAFLD . We believe that TE provides the opportunity of noninvasive screening of NAFLD in CKD patients . In further prospect i ve analysis , we believe that by using TE as noninvasive method we could investigate are ACE-I/ARBs really effective medications for the treatment of NAFLD in CKD patients .ZusammenfassungGrundlagenKürzlich berichtete Ergebnisse deuten darauf hin , dass das Renin-Angiotensin System ( RAAS ) von Bedeutung für die Pathogenese der nicht-alkoholischen Fettleber ( NAFLD ) sein könnte . Wir untersuchten , ob bei Patienten mit verschiedenen Stadien einer chronischen Nierenerkrankung ( CKD ) eine Therapie mit Blockern des RAAS eine Wirkung auf den Steatose- beziehungsweise Fibrose-Grad ( dokumentiert mittels transienter Elastographie ( TE ) – Fibroscan ® -CAP ) der Leber ausübt . Method ikEs wurden 191 Patienten mit verschiedenen Stadien der Niereninsuffizienz untersucht : 61 Patienten waren i m Stadium III der CKD , 62 Patienten waren i m Endstadium der Niereninsuffizienz und an der chronischen Hämodialyse , 68 Patienten waren Nierentransplantatempfänger . Als Parameter zur Quantifizierung der Leberfibrose wurde die Steifheit der Leber herangezogen . Außerdem wurde mit Hilfe der TE der „ Controlled Attenuation Parameter ( CAP ) “ zur Erkennung und Quantifizierung einer Steatose der Leber verwendet . ErgebnisseDie CKD Patienten ( p = 0,05 ) und die CKD-NAFLD Patienten ( p = 0,0005 ) , die mit ACE Hemmern oder Angiotensinrezeptorblockern beh and elt worden waren , hatten i m Vergleich zu den Patienten ohne diese Medikation einen statistisch signifikant niedrigeren Grad der Lebersteifheit . In Bezug auf die Steatose beziehungsweise den Fibrosegrad der Leber war kein statistisch signifikanter Einfluss der Medikation zu erheben . SchlussfolgerungUnsere Ergebnisse lassen den Schluss zu , dass RAAS Blocker eine attraktive Option beim Management der NAFLD sein könnten . Wir glauben , dass die TE eine Möglichkeit bietet , bei CKD Patienten nicht invasiv auf NAFLD zu screenen Telmisartan , a new angiotensin II type 1 receptor blocker ( ARB ) , was recently reported to stimulate PPARgamma , and stronger effects of Telmisartan on insulin sensitivity has been expected than the class effect of ARB . In the present study , we examined the effects of Telmisartan on insulin sensitivity and adipokine levels in hypertensive and type 2 diabetic patients . Out patients with both hypertension and type 2 diabetes mellitus ( n=36 ; male 23 , female 13 ) , received 20 - 40 mg Telmisartan orally once daily for 6 months . Physical examinations and blood or urine tests were performed before and 3 or 6 months after starting Telmisartan treatment . Results were statistically compared using Wilcoxon analysis . Telmisartan treatment for 3 or 6 months reduced systolic and diastolic blood pressure and urinary albumin excretion . Fasting plasma glucose , HbA1c , total and HDL-cholesterol , triglyceride , body weight , BMI and waist length were not changed . Fasting IRI and HOMA-IR were significantly decreased after Telmisartan treatment , suggesting the improved insulin sensitivity . Total and high molecular adiponectin were not changed . Interestingly , serum leptin was significantly increased by 3 months Telmisartan treatment , suggesting a possible involvement of leptin in improved insulin sensitivity . In conclusion , Telmisartan improved insulin resistance with increased serum leptin level in hypertensive and type 2 diabetic patients Introduction Non-alcoholic fatty liver disease ( NAFLD ) is a common liver disease worldwide . Experimental and small clinical trials have demonstrated that angiotensin II blockers ( ARB ) may be anti-fibrotic in the liver . The aim of this r and omised controlled trial was to assess whether treatment with Losartan for 96 weeks slowed , halted or reversed the progression of fibrosis in patients with non-alcoholic steatohepatitis ( NASH ) . Methods Double-blind r and omised-controlled trial of Losartan 50 mg once a day versus placebo for 96 weeks in patients with histological evidence of NASH . The primary outcome for the study was change in histological fibrosis stage from pre-treatment to end-of-treatment . Results The study planned to recruit 214 patients . However , recruitment was slower than expected , and after 45 patients were r and omised ( median age 55 ; 56 % male ; 60 % diabetic ; median fibrosis stage 2 ) , enrolment was suspended . Thirty-two patients ( 15 losartan and 17 placebo ) completed follow up period : one patient ( 6.7 % ) treated with losartan and 4 patients ( 23.5 % ) in the placebo group were “ responders ” ( lower fibrosis stage at follow up compared with baseline ) . The major reason for slow recruitment was that 39 % of potentially eligible patients were already taking an ARB or angiotensin converting enzyme inhibitor ( ACEI ) , and 15 % were taking other prohibited medications . Conclusions Due to the widespread use of ACEI and ARB in patients with NASH this trial failed to recruit sufficient patients to determine whether losartan has anti-fibrotic effects in the liver . Trial registration IS RCT N Saga Telmisartan Aggressive Research ( STAR ) is a single-arm , prospect i ve multi-center trial to evaluate the effectiveness of treatment with telmisartan in patients with hypertension . A total of 197 patients with a systolic blood pressure of > or = 140 or a diastolic blood pressure of > or = 90 mmHg were enrolled in this study , and were prescribed 20 to 80 mg/day of telmisartan for 6 months . In all patients , both systolic and diastolic blood pressures decreased ( 159+/-20 to 135+/-12 mmHg , p<0.0001 , 87+/-12 to 75+/-8 mmHg , p<0.0001 , respectively ) . In addition , total cholesterol ( TC ) levels decreased from 200+/-40 to 188+/-33 mg/dl ( p<0.05 ) . In patients with TC > or = 220 mg/dl , the change was more striking ( 249+/-33 to 204+/-31 mg/dl , p<0.0001 ) . Even in patients receiving statins , TC levels still were decreased ( 216+/-51 to 190+/-31 mg/dl , p<0.02 ) . In addition , TC levels were also decreased even in patients receiving telmisartan in exchange for other ARBs with TC > or = 220 mg/d . Triglyceride ( TG ) levels were decreased ( 270+/-199 to 175+/-74 mg/dl , p<0.005 ) in patients with TG levels > or = 150 mg/dl . Fasting blood glucose ( FBG ) was decreased ( 158+/-68 to 138+/-60 mg/dl , p<0.05 ) in patients with FBG > or = 110 mg/dl . These results suggest that telmisartan may have favorable effects on lipid and glucose metabolism , in addition to lowering blood pressure . The profound effect of telmisartan to lower cholesterol suggests a potential use in hypertensive patients with dyslipidemia Fatty liver is one of the local morphological manifestations of metabolic syndrome and is frequently associated with insulin resistance . Insulin resistance is also common in patients with chronic hepatitis C. Hyperinsulinemia is an independent risk factor for hypertension and cardiovascular mortality . The aim of this study was to evaluate the therapeutic efficacy of angiotensin II receptor blockers ( ARBs ) , telmisartan and olmesartan , for patients with non-alcoholic fatty liver disease ( NAFLD ) and chronic hepatitis C ( CH-C ) . We analyzed the incidence of obesity , insulin resistance , and other disorders in patients with NAFLD ( Group A ) , CH-C ( Group B ) , or other liver diseases ( Group C ) . We evaluated whether the ARBs , telmisartan and olmesartan , improved insulin resistance and liver injury by measuring the homeostasis model assessment ratio of insulin resistance ( HOMA-IR ) and serum alanine aminotransferase ( ALT ) . The incidence of obesity ( BMI > or = 25 kg/m2 ) was significantly higher in Group A than in Groups B and C. The incidence of insulin resistance ( HOMA-IR > or = 2.5 ) in Groups A and B was significantly higher than in Group C. Regular doses of telmisartan and olmesartan significantly improved HOMA-IR and ALT levels not only in NAFLD patients but also in patients with CH-C. The effects tended to be more notable with telmisartan . In conclusion , telmisartan and olmesartan improved insulin sensitivity and may possibly be used as liver protecting agents in CH-C as well as NAFLD patients UNLABELLED Medication combinations that improve the efficacy of thiazolidinediones or ameliorate weight-gain side effects of therapy represent an attractive potential treatment for ( NASH ) . The aim of this r and omized , open-label trial was to assess the efficacy of rosiglitazone and metformin in combination versus rosiglitazone and losartan , compared to rosiglitazone alone , after 48 weeks of therapy . A total of 137 subjects with biopsy-proven NASH were enrolled and r and omly assigned to receive either 4 mg twice-daily of rosiglitazone , 4 mg of rosiglitazone and 500 mg of metformin twice-daily , or 4 mg of rosiglitazone twice-daily and 50 mg of losartan once-daily for 48 weeks . Patients were screened for other etiologies of chronic liver disease , including daily alcohol intake in excess of 20 g. Repeat liver biopsy was performed after 48 weeks of therapy and review ed in a blinded fashion by a single expert hepatopathologist . The primary aim of the study was to assess for differences between treatment groups in the improvement of steatosis , hepatocellular inflammation , and fibrosis . In total , 108 subjects completed the trial . Primary outcome revealed no significant difference between treatment groups in all histologic parameters ( steatosis , P = 0.137 ; hepatocellular inflammation , P = 0.320 ; fibrosis , P = 0.229 ) . Overall improvement in steatosis , hepatocellular inflammation , ballooning degeneration , and fibrosis was observed ( P ≤ 0.001 ) . Serum aminotransferases were reduced in all three groups ( P < 0.001 within treatment , P > 0.05 between groups ) . Metformin did not significantly mitigate weight gain ( P = 0.051 ) . CONCLUSIONS Forty-eight weeks of combination therapy with rosiglitazone and metformin or rosiglitazone and losartan confers no greater benefit than rosiglitazone alone with respect to histopathology AIM To evaluate insulin resistance , cytolysis and non-alcoholic steatohepatitis ( NASH ) score ( NAS ) using the Kleiner and Brunt criteria in 54 patients with NASH and mild-to-moderate hypertension , treated with telmisartan vs valsartan for 20 mo . METHODS All patients met the NCEP-ATP III criteria for metabolic syndrome . Histology confirmed steatohepatitis , defined as a 
    Output:
    
Conclusions Although ARBs significantly decreased plasma low-density lipoprotein and total cholesterol levels , the current evidence is insufficient to support the efficacy of ARBs in managing fibrosis in NAFLD patients