Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: a randomized controlled trial.
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.
De
Binay-K
BK
Department of Medicine, Medical College Calcutta 88, Calcutta 700030, India. binaykde@hotmail.com
Dutta
Deep
D
Som
Rimi
R
Biswas
Pranab-K
PK
Pal
Subrata-K
SK
Biswas
Anirban
A
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*
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D013148:Spironolactone; D011433:Propranolol