Plasma volume contraction in portal hypertension.
The effect of blood volume contraction induced by a 4-week regimen of spironolactone (100 mg/day) or furosemide (40 mg/day) on the hepatic venous pressure gradient (HVPG), an indicator of portal hypertension, was evaluated in patients with cirrhosis and no ascites. In the spironolactone group (n = 15), HVPG decreased significantly from 16.5 +/- 0.9 mmHg (mean +/- S.E.M.) to 12.9 +/- 1.0 mmHg (P < 0.005) and total blood volume contracted significantly from 4338 +/- 231 ml to 4006 +/- 203 ml (n = 14, P < 0.01). Although the HVPG changes did not correlate significantly with changes in measured total blood volume or in simultaneously determined systemic haemodynamics, a significant inverse correlation (r = -0.74, P < 0.01, n = 12) was found between the HVPG change and posttreatment plasma aldosterone levels, attesting to the effectiveness of spironolactone therapy in lowering HVPG. In the furosemide group (n = 10), neither HVPG (13.7 +/- 0.3 mmHg vs. 13.6 +/- 0.9 mmHg) nor total blood volume (4961 +/- 153 ml vs. 4964 +/- 162 ml) declined significantly. These results show that long-term administration of spironolactone to patients with cirrhosis and no ascites produced a significant reduction in HVPG that may have been due to gradual, sustained volume contraction. Thus, spironolactone may prove to be an effective treatment for portal hypertension in cirrhosis without ascites.
First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Y
Y
Katsuta
T
T
Aramaki
T
T
Sekiyama
K
K
Satomura
H
H
Okumura
H ]
H]
Okumura K [corrected to Okumura
D000368:Aged; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008099:Liver / Q000098:blood supply / Q000502:physiology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010953:Plasma Volume; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D013148:Spironolactone / Q000627:therapeutic use; D013997:Time Factors
D013148:Spironolactone; D000450:Aldosterone; D005665:Furosemide