title: Impaired reactivity of the peripheral vasculature to pressor agents in alcoholic cirrhosis.
abstract: BACKGROUND
  Studies of the in vivo vascular reactivity of the peripheral circulation to pressor agents in cirrhosis have produced conflicting results, possibly because of changes in mean arterial pressure that make it difficult to clearly separate peripheral and central effects. The aim of the present study was to assess the reactivity of the forearm circulation to pressor agents in vivo without activating central control systems.
  
  
  METHODS
  Forearm blood flow was measured by venous occlusion strain gauge plethysmography in the basal state and during the infusion of subpressor doses of norepinephrine and angiotensin II into the brachial artery in 10 male patients with well-compensated alcoholic cirrhosis and 10 male age-matched controls. Plasma renin activity and aldosterone and angiotensin II concentrations were assayed. Forearm and systemic sympathetic nervous system activity was estimated using a norepinephrine spillover technique.
  
  
  RESULTS
  Basal forearm blood flow, renin angiotensin aldosterone system activity, and forearm sympathetic nervous system activity were similar in both the control and cirrhotic groups. The cirrhotic patients showed an impaired response to both norepinephrine and angiotensin II.
  
  
  CONCLUSIONS
  There is impaired reactivity of the peripheral vasculature to pressor agents in cirrhosis, indicating that the control of vascular tone is disturbed even in well-compensated cirrhosis.
authors.affiliation: Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Ryan
authors.forename: K
authors.initials: K
authors.lastname: Sudhir
authors.forename: G
authors.initials: G
authors.lastname: Jennings
authors.forename: M
authors.initials: M
authors.lastname: Esler
authors.forename: F
authors.initials: F
authors.lastname: Dudley
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000704:Analysis of Variance; D000804:Angiotensin II / Q000097:blood / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005542:Forearm / Q000098:blood supply; D006801:Humans; D007261:Infusions, Intra-Arterial; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood / Q000494:pharmacology*; D010991:Plethysmography; D012039:Regional Blood Flow / Q000187:drug effects; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000502:physiology; D013564:Sympathetic Nervous System / Q000502:physiology
chemical_list: D000804:Angiotensin II; D000450:Aldosterone; D012083:Renin; D009638:Norepinephrine