title: Nadolol is superior to isosorbide mononitrate for the prevention of the first variceal bleeding in cirrhotic patients with ascites.
abstract: OBJECTIVE
  beta-blockers effectively prevent first variceal bleeding (FVB) in cirrhotic patients. In patients with ascites, however, their use might be precluded by a high rate of contraindications and side effects. We compared the efficacy and applicability of nadolol and isosorbide-mononitrate (IsMn) in preventing FVB in a population of cirrhotic patients at high risk of variceal bleeding with ascites, who can be frequently intolerant to beta-blockers.
  
  
  METHODS
  A total of 80 consecutive cirrhotic patients with ascites and esophageal varices (25% average risk of bleeding at 1 year) were considered, 28 were excluded due to contraindications and 52 were randomly assigned to receive nadolol (n=25) or IsMn (n=27).
  
  
  RESULTS
  Frequency of contraindications was greater for beta-blockers than IsMn (35 versus 0%, P=0.001). During 21.3+/-11.6 months of follow-up, side effects forced six patients taking nadolol and four taking IsMn to stop treatment. Bleeding occurred in two patients taking nadolol and ten taking IsMn. The probability of bleeding was significantly lower in the nadolol group (P<0.05), whereas overall survival was similar (seven patients on IsMn and eight on nadolol died, P=0.3).
  
  
  CONCLUSIONS
  In patients with ascites IsMn is tolerated but ineffective while nadolol is effective but less tolerated.
authors.affiliation: Medicina Generale, Ospedale G. Fornaroli, Magenta, Italy.
authors.forename: Gianmario
authors.initials: G
authors.lastname: Borroni
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Massimo
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Franco
authors.initials: F
authors.lastname: Bissoli
authors.forename: Elettra
authors.initials: E
authors.lastname: Lorenzano
authors.forename: Alessandra
authors.initials: A
authors.lastname: Maggi
authors.forename: Stefania
authors.initials: S
authors.lastname: Visentin
authors.forename: Anna
authors.initials: A
authors.lastname: Panzeri
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications / Q000401:mortality; D001794:Blood Pressure; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006339:Heart Rate; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D007668:Kidney / Q000502:physiology; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000008:administration & dosage*; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate