title: Nadolol plus spironolactone in the prophylaxis of first variceal bleed in nonascitic cirrhotic patients: A preliminary study.
abstract: Treatment with beta-blockers fails to decrease portal pressure in nearly 40% of cirrhotic patients. Recent studies have suggested that treatment with spironolactone reduces pressure and flow in the portal and variceal systems. This trial was designed to assess if nadolol plus spironolactone is more effective than nadolol alone to prevent the first variceal bleeding. One hundred patients with medium and large varices who had never bled and were without ascites were included in a prospective, randomized, multicenter, double-blind, placebo-controlled trial. The patients were randomized into 2 groups: 51 received nadolol plus placebo (N + P) and 49 received nadolol plus spironolactone 100 mg/d (N + S). Hepatic venous pressure gradient (HVPG) and activity of the renin-aldosterone system (plasma renin activity/plasma aldosterone levels) were measured in 24 patients. There were no significant differences in the appearance of variceal bleeding and ascites between groups at a mean follow-up of 22 +/- 16 months. However, analyzing both complications together, the incidence was significantly higher in the N + P group than in the N + S group (39% vs. 20%; P <.04). Clinical ascites was also higher in patients in the N + P group than in the N + S group (21% vs. 6%; P <.04). Significant increases in plasma renin activity and plasma aldosterone levels were only observed in patients in the N + S group (P <.01). The cumulative probabilities of remaining free of bleeding and ascites were similar in both groups after 70 months of follow-up. In conclusion, these results suggest that nadolol plus spironolactone does not increase the efficacy of nadolol alone in the prophylaxis of the first variceal bleeding. However, when bleeding and ascites were considered together, the combined therapy effectively reduced the incidence of both portal-hypertensive complications.
authors.affiliation: Liver Unit, Hospital de Gastroenterología B. Udaondo, Buenos Aires, Argentina. raquelabecasisabril@hotmail.com
authors.forename: Raquel
authors.initials: R
authors.lastname: Abecasis
authors.forename: David
authors.initials: D
authors.lastname: Kravetz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fassio
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ameigeiras
authors.forename: Daniel
authors.initials: D
authors.lastname: Garcia
authors.forename: Rogelio
authors.initials: R
authors.lastname: Isla
authors.forename: Graciela
authors.initials: G
authors.lastname: Landeira
authors.forename: Nora
authors.initials: N
authors.lastname: Dominguez
authors.forename: Gustavo
authors.initials: G
authors.lastname: Romero
authors.forename: Julio
authors.initials: J
authors.lastname: Argonz
authors.forename: Ruben
authors.initials: R
authors.lastname: Terg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009248:Nadolol / Q000627:therapeutic use*; D013148:Spironolactone / Q000627:therapeutic use*; D013152:Splanchnic Circulation / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D009248:Nadolol