Effects of long-term propranolol and octreotide on postprandial hemodynamics in cirrhosis: a randomized, controlled trial.
OBJECTIVE
Postprandial increases in portal pressure may influence esophageal variceal rupture. The effects of chronic propranolol and octreotide (100 and 200 microg subcutaneously in a single dose) on postprandial hemodynamics were evaluated.


METHODS
FIRST STUDY: 36 cirrhotic patients were studied at baseline and 30 and 60 minutes after a standard meal and then treated with propranolol (139 +/- 9 mg/d during 39 +/- 2 days). SECOND STUDY: After baseline measurements, patients were randomized into 3 groups: (1) placebo, (2) octreotide (100 microg), or (3) octreotide (200 microg) (n = 12 for each group). Thirty minutes postinjection a new baseline was established and measurements were repeated 30 and 60 minutes after the meal.


RESULTS
First study: Baseline portal pressure was 18.1 +/- 1.2 mm Hg, 30 and 60 minutes after the meal it was 21.5 +/- 0.8 mm Hg and 20.5 +/- 0.8 mm Hg, respectively (both P < 0.01 vs. baseline). Cardiac index (CI) was 4.5 +/- 0.2, 4.8 +/- 0.2, and 4.9 +/- 0.2 L x min(-1) x m(-2), respectively (both P < 0.05 vs. baseline). Peripheral vascular resistance was 1012 +/- 56, 902 +/- 51 (P = NS), and 884 +/- 49 dynes x sec x cm(-5) (P< 0.05 vs. baseline), respectively. Second study: Propranolol and placebo did not blunt postprandial increase in portal pressure. Octreotide (100 microg) partially ameliorated postprandial increase in portal pressure. Octreotide (200 microg) significantly enhanced the portal hypotensive effect of propranolol and blunted the postprandial increase in portal pressure.


CONCLUSIONS
Octreotide blunts postprandial increase in portal pressure not prevented by long-term propranolol administration.
Vorobioff
Julio D
JD
Liver Unit and Hepatic Hemodynamic Laboratory, Fundación Dr. J. R. Villavicencio & Sanatorio Parque, Rosario, Argentina. vorodiez@intramed.net.ar
Gamen
Marcelo
M
Kravetz
David
D
Picabea
Eduardo
E
Villavicencio
Roberto
R
Bordato
Juan
J
Ruf
Andrés
A
Bessone
Fernando
F
Romero
Gustavo
G
Palazzi
Jorge
J
Nicora
Alicia
A
Passamonti
María
M
Tanno
Hugo
H
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D002404:Catheterization; D004359:Drug Therapy, Combination; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D008102:Liver Circulation / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D017082:Portal Pressure / Q000187:drug effects; D019518:Postprandial Period; D011433:Propranolol / Q000008:administration & dosage*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000319:Adrenergic beta-Antagonists; D014662:Vasoconstrictor Agents; D011433:Propranolol; D015282:Octreotide