Continuous prazosin administration in cirrhotic patients: effects on portal hemodynamics and on liver and renal function.
OBJECTIVE
Hepatic vascular resistance is influenced by alpha-adrenergic tone. The aim of this study was to investigate the effects of continuous blockade of alpha-adrenoceptors with prazosin on hemodynamics, liver function, and renal function and whether the association of propranolol or furosemide enhances the portal pressure lowering effect of prazosin.


METHODS
Cirrhotic patients with portal hypertension were studied at baseline and after a 3-month course of prazosin (n = 18) or placebo (n = 10).


RESULTS
No changes were observed in the placebo group. Prazosin decreased the hepatic venous pressure gradient (HVPG) while increasing hepatic blood flow. Liver function improved as shown by an increase in hepatic and intrinsic hepatic clearances of indocyanine green and galactose elimination capacity. A significant reduction in mean arterial pressure and systemic vascular resistance was associated with increases in plasma renin activity and aldosterone concentration and a decrease in glomerular filtration rate. The plasma volume increased significantly, and 6 patients developed edema. The association of propranolol (n = 8) but not furosemide (n = 7) to prazosin increased the reduction in HVPG and attenuated the increase in plasma renin activity.


CONCLUSIONS
In cirrhotic patients, continuous prazosin administration reduces portal pressure and improves liver perfusion and function but favors sodium and water retention. The association of propranolol enhances the decrease in portal pressure, suggesting a potential benefit from this combined therapy.
Albillos
A
A
Department of Gastroenterology, Clínica Puerta de Hierro, Madrid, Spain.
Lledó
J L
JL
Rossi
I
I
Pérez-Páramo
M
M
Tabuenca
M J
MJ
Bañares
R
R
Iborra
J
J
Garrido
A
A
Escartín
P
P
Bosch
J
J
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage* / Q000494:pharmacology; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005665:Furosemide / Q000494:pharmacology; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects*; D008099:Liver / Q000187:drug effects*; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000187:drug effects*; D011224:Prazosin / Q000008:administration & dosage* / Q000494:pharmacology; D011433:Propranolol / Q000494:pharmacology; D012083:Renin / Q000097:blood; D014655:Vascular Resistance / Q000187:drug effects; D014690:Venous Pressure / Q000187:drug effects
D000317:Adrenergic alpha-Antagonists; D000450:Aldosterone; D005665:Furosemide; D011433:Propranolol; D012083:Renin; D011224:Prazosin