Hemodynamic effect of spironolactone in liver cirrhosis and propranolol-resistant portal hypertension.
OBJECTIVE
In a proportion of patients with liver cirrhosis, portal pressure does not decrease adequately with propranolol. These patients may benefit from another drug that may reduce portal pressure. We evaluated the role of spironolactone, alone or with propranolol, in such patients.


METHODS
Patients with cirrhosis, with or without ascites, with esophageal varices and with hepatic venous pressure gradient exceeding 12 mmHg, which did not show a 20% reduction after an 80-mg oral dose of propranolol, were studied. They were allocated to receive spironolactone 100 mg orally once daily either alone (group 1, n=10) or with propranolol 40 mg orally twice daily (group 2, n=10), for 7 days, after which the hemodynamic study was repeated.


RESULTS
Hepatic venous pressure gradient decreased in those receiving spironolactone and propranolol (p=0.007); 5 patients in group 1 and 7 in group 2 showed a reduction in hepatic venous pressure gradient by more than 20%. However, the reduction produced by spironolactone alone (20.5 [31.3]%) was not significantly different from that produced by combination therapy (30.3 [25.9]%; p=0.46).


CONCLUSIONS
Spironolactone in combination with propranolol achieves adequate reduction (> or = 20%) in hepatic venous pressure gradient in propranolol-resistant portal hypertension in patients with liver cirrhosis. Spironolactone alone was also effective in some patients.
Sen
Sambit
S
Department of Medicine, Institute of Post Graduate Medical Education and Research, Calcutta.
De
Binay K
BK
Biswas
Pranab K
PK
Biswas
Jayanta
J
Das
Debasish
D
Maity
Ajit K
AK
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000517:prevention & control; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011168:Portal System / Q000187:drug effects*; D011433:Propranolol / Q000627:therapeutic use*; D013148:Spironolactone / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D013148:Spironolactone; D011433:Propranolol