title: Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: a randomized controlled trial.
abstract: OBJECTIVE
  To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding.
  
  
  METHODS
  Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day.
  
  
  RESULTS
  Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to <= 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05).
  
  
  CONCLUSIONS
  Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.
authors: Department of Medicine, Medical College Calcutta 88, Calcutta 700030, India. binaykde@hotmail.com
authors: Binay-K
authors: BK
authors: De
authors: Deep
authors: D
authors: Dutta
authors: Rimi
authors: R
authors: Som
authors: Pranab-K
authors: PK
authors: Biswas
authors: Subrata-K
authors: SK
authors: Pal
authors: Anirban
authors: A
authors: Biswas
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D013148:Spironolactone; D011433:Propranolol