Current pharmacotherapy in the management of cirrhosis: focus on the hyperdynamic circulation.
Many major complications of hepatic cirrhosis relate to the development of a characteristic hyperdynamic circulatory state in these patients, irrespective of the underlying disease aetiology. Vasodilatation of the systemic and splanchnic circulations leads to a reduced total systemic vascular resistance, increased cardiac output and intense activation of neurohumoral vasoconstrictor systems including the sympathetic nervous system, renin-angiotensin system and vasopressin. Vasoconstriction of the renal and hepatic circulations contributes to the development of renal failure and portal hypertension, respectively. Current treatments that focus on amelioration of these circulatory derangements offer much promise, however, they are often limited by side effects in these patients.
Wynn Domain, Baker Heart Research Institute, PO Box 6492, St Kilda Road Central, Melbourne, Victoria 8008, Australia.
Rhys B
RB
Vaughan
Jaye P F
JP
Chin-Dusting
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D001775:Blood Circulation / Q000502:physiology; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology*; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D051437:Renal Insufficiency / Q000188:drug therapy / Q000503:physiopathology*
D000319:Adrenergic beta-Antagonists; D004232:Diuretics