Effect of propranolol on the splanchnic and peripheral renin angiotensin system in cirrhotic patients.
OBJECTIVE
To evaluate the effect of beta-blockade on angiotensins in the splanchnic and peripheral circulation of cirrhotic patients and also to compare hemodynamic parameters during liver transplantation according to propranolol pre-treatment or not.


METHODS
Patients were allocated into two groups: outpatients with advanced liver disease(LD) and during liver transplantation(LT). Both groups were subdivided according to treatment with propranolol or not. Plasma was collected through peripheral venipuncture to determine plasma renin activity(PRA), Angiotensin(Ang) I, Ang II, and Ang-(1-7) levels by radioimmunoassay in LD group. During liver transplantation, hemodynamic parameters were determined and blood samples were obtained from the portal vein to measure renin angiotensin system(RAS) components.


RESULTS
PRA, Ang I, Ang II and Ang-(1-7) were significantly lower in the portal vein and periphery in all subgroups treated with propranolol as compared to non-treated. The relationships between Ang-(1-7) and Ang I levels and between Ang II and Ang I were significantly increased in LD group receiving propranolol. The ratio between Ang-(1-7) and Ang II remained unchanged in splanchnic and peripheral circulation in patients under beta-blockade, whereas the relationship between Ang II and Ang I was significantly increased in splanchnic circulation of LT patients treated with propranolol. During liver transplantation, cardiac output and index as well systemic vascular resistance and index were reduced in propranolol-treated subgroup.


CONCLUSIONS
In LD group, propranolol treatment reduced RAS mediators, but did not change the ratio between Ang-(1-7) and Ang II in splanchnic and peripheral circulation. Furthermore, the modification of hemodynamic parameters in propranolol treated patients was not associated with changes in the angiotensin ratio.
Vilas-Boas
Walkíria Wingester
WW
Laboratório de Hipertensão, Departamento de Fisiologia e Biofísica, ICB-UFMG, Av. Antonio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil.
Ribeiro-Oliveira
Antônio
A
Ribeiro
Renata da Cunha
Rda C
Vieira
Renata Lúcia Pereira
RL
Almeida
Jerusa
J
Nadu
Ana Paula
AP
Simões e Silva
Ana Cristina
AC
Santos
Robson Augusto Souza
RA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000803:Angiotensin I / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D000809:Angiotensins / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011169:Portal Vein; D011433:Propranolol / Q000627:therapeutic use*; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013152:Splanchnic Circulation
D000319:Adrenergic beta-Antagonists; D000809:Angiotensins; D010446:Peptide Fragments; D000804:Angiotensin II; D000803:Angiotensin I; D011433:Propranolol; D012083:Renin; C118790:angiotensin I (1-7)