Acute and chronic hemodynamic effects of propranolol in unselected cirrhotic patients

Abstract

Different and contradictory results concerning the use of propranolol in the treatment of portal hypertension have been reported. This study was designed to investigate the hemodynamic effects of short- and long-term administration of propranolol in portal hypertensive patients. Portal pressure, cardiac index, heart rate and blood pressure were obtained in 18 unselected alcoholic cirrhotic patients with esophageal varices before and 60 min after the oral administration of 40 mg propranolol and again after 106 ± 35 days of continuous oral administration (mean dose = 158 ± 63 mg per day). Baseline portal pressure was 21.7 ± 7.2 mm Hg. It decreased after 60 min to 17.2 ± 5.5 mm Hg (p < 0.01) and after long-term administration of propranolol to 16.1 ± 5.7 mm Hg (p < 0.01). No decrease in portal pressure was noted in 9 of 18 (50%) patients after acute administration and 5 of 17 (30%) patients after long-term administration. Baseline cardiac index was 5.1 ± 1.2 liters. min^-1 m^-2. It decreased after 60 min to 3.9 ± 1.4 liters. min^-1 m^-2 (p < 0.01) and to 3.6 ± 1.0 liters. min^-1 m^-2 after long-term administration (p < 0.001). Baseline heart rate was 85 ± 11 beats per min. It decreased after 60 min to 75 ± 9 (p < 0.001) and after long-term administration to 62 ± 6 (p < 0.001) beats per min. Baseline mean arterial pressure was 108 ± 11 mm Hg. It decreased after 60 min to 97 ± 14 mm Hg (p < 0.01) and after long-term administration to 103 ± 14 mm Hg (not statistically significant). No significant correlations were found between the decrease in portal pressure and cardiac index nor between portal pressure and heart rate reductions This study shows that, in unselected cirrhotic patients, propranolol administration fails to decrease portal pressure in a significant proportion of them. This parameter should be measured in every patient under pharmacologic treatment of portal hypertension, and its reduction should not be inferred through other hemodynamic measurements.