Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture.
OBJECTIVE
The aim of this study was to evaluate cardiovascular and renal function in patients with compensated cirrhosis and essential hypertension in the supine position and in response to standing up.


METHODS
Twenty-four patients with compensated cirrhosis (12 with elevated arterial pressure) and 20 healthy volunteers underwent echocardiographic evaluation of left ventricular end-diastolic and stroke volumes, ejection fraction, cardiac index, arterial pressure, peripheral resistance, creatinine clearance and sodium excretion in both the supine and the standing position.


RESULTS
When supine, only normotensive patients had a hyperdynamic circulation, with increased left ventricular end-diastolic and stroke volumes, cardiac index, and ejection fraction, and reduced peripheral resistance. Creatinine clearance and sodium excretion were comparable in patients and controls. Standing induced a decrease in end-diastolic volume in all subjects. Healthy volunteers maintained cardiovascular homeostasis by increasing ejection fraction and heart rate, while both normotensive and hypertensive cirrhotic patients experienced a fall in stroke volume and cardiac index, despite a marked activation of the renin-aldosterone and sympathetic nervous system. Creatinine clearance decreased only in normotensive patients, who experienced the greatest reduction in sodium excretion.


CONCLUSIONS
Compensated cirrhotic patients with arterial hypertension had no evidence of hyperdynamic circulation. Like their normotensive counterparts, hypertensive patients had an impaired cardiovascular response to the postural challenge, but a lesser degree of renal dysfunction during standing.
Gentilini
P
P
Istituto di Medicina Interna, University of Florence School of Medicine, Italy. p.gentilini@dfc.unifi.it
Romanelli
R G
RG
Laffi
G
G
Barletta
G
G
Del Bene
R
R
Messeri
G
G
La Villa
G
G
D000368:Aged; D001794:Blood Pressure; D003404:Creatinine / Q000378:metabolism*; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D006977:Hypertension, Renal / Q000209:etiology; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011187:Posture; D012016:Reference Values; D012964:Sodium / Q000097:blood; D013318:Stroke Volume; D016683:Supine Position; D014655:Vascular Resistance; D016277:Ventricular Function, Left
D012964:Sodium; D003404:Creatinine