Daily variation in portal blood flow and the effect of propranolol administration in a randomized study of patients with cirrhosis.
A nocturnal increase in portal pressure and blood flow was demonstrated in patients with cirrhosis, suggesting that these hemodynamic changes may contribute to the triggering of the hemorrhagic episodes observed during the night in these patients. It is known that propranolol reduces portal flow, thus reducing the risk of variceal bleeding. In a double-blind, placebo-controlled study, we evaluated the effect of long-term propranolol administration on the daily fluctuation of systemic and splanchnic hemodynamic parameters in 14 patients with cirrhosis. Cardiac output and portal blood flow were measured by the Doppler technique. A daily fluctuation of both cardiac output and portal blood flow was observed, peaking at midnight. beta-Adrenergic blockade was manifested by a significant reduction in heart rate (-21% +/- 4%, P < .01) and cardiac output (-12% +/- 2%, P < .05). A significant decrease in portal blood flow (-20% +/- 4%, P < .01) was also observed in these patients. Propranolol administration blunted the time-related changes in cardiac output and portal blood flow. In contrast, patients receiving placebo had a nocturnal peak of both parameters similar to that observed under basal conditions. Our study shows that chronic propranolol administration abolishes the nocturnal peak of portal blood flow in patients with cirrhosis and indicates a preventive effect of propranolol in these patients.
Alvarez
D
D
Seccion Ecografia, Universidad de Buenos Aires, Argentina.
de las Heras
M
M
Abecasis
R
R
Terg
R
R
Gerona
S
S
Albornoz
L
L
Galdame
O
O
Torres
J
J
Mastai
R
R
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D002302:Cardiac Output / Q000187:drug effects; D002940:Circadian Rhythm / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000187:drug effects* / Q000502:physiology; D011433:Propranolol / Q000494:pharmacology*; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D011433:Propranolol