title: Effects of treatment with β-blocker and aldosterone antagonist on central and peripheral haemodynamics and oxygenation in cirrhosis.
abstract: OBJECTIVE
  Patients with cirrhosis often exhibit abnormalities in cardiovascular regulation and oxygenation. Many of these patients are treated with β-blockers and aldosterone antagonists that may influence the regulation of systemic haemodynamics, but the specific effects on systemic haemodynamics and oxygenation are less studied. We therefore investigated systemic haemodynamics and oxygenation in patients with cirrhosis before and after 3 weeks of treatment with propranolol or spironolactone.
  
  
  METHODS
  Twenty-two patients with cirrhosis were allocated into three groups as follows: a β-blocker group (n=7), a spironolactone group (n=8) and a control group (n=7). At baseline, and after 3 weeks, we measured the arterial blood pressure (BP), heart rate, Q-T frequency-corrected interval, baroreflex sensitivity, cardiac output, peripheral arterial inflow (ABFin), transcutaneous oxygenation and hormonal status. We also assessed immediate effects of propranolol in the β-blocker group.
  
  
  RESULTS
  Short-term and long-term β-blockade significantly reduced BP (-7%) and heart rate (-15%) (P<0.01). Short-term β-blocker treatment improved the Q-T frequency-corrected interval but reduced the transcutaneous oxygenation (P<0.05). Baroreflex sensitivity and brain natriuretic peptide increased after short-term and after 3 weeks of β-blocker treatments (P<0.01). After 3 weeks, β-blockers reduced cardiac output and ABFin by 13 and 26%, respectively (P<0.05-0.01). In the spironolactone group, BP decreased by 8% (P<0.05) and renin increased by 370% (P<0.01). No changes were seen in the control group.
  
  
  CONCLUSIONS
  Short-term and long-term treatments with β-blockers and aldosterone antagonist modestly affect haemodynamics and oxygenation. Careful monitoring, especially in patients with low arterial blood pressure, if cardiac dysfunction is suspected, should follow the administration of β-blockers.
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christine
authors.initials: C
authors.lastname: Winkler
authors.forename: Lise
authors.initials: L
authors.lastname: Hobolth
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood*; D013148:Spironolactone / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D010100:Oxygen