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Acute effect of propranolol and isosorbide-5-mononitrate administration on renal blood flow in cirrhotic patients


Background—Propranolol and isosorbide-5-mononitrate (ISMN) are increasingly used in the prophylaxis of variceal haemorrhage in cirrhosis. However, recent studies have suggested that these drugs may compromise renal function, possibly by reducing renal blood flow.

Aims—To assess the acute effects of propranolol and ISMN on renal blood flow and other haemodynamic parameters in cirrhosis.

Patients and methods—Twenty six cirrhotic patients were given either 80 mg propranolol, 20 mg ISMN, or a combination of the two drugs. Unilateral renal blood flow (RBF), azygos blood flow (AZBF), hepatic venous pressure gradient (HVPG), mean arterial pressure (MAP), and heart rate (HR) were recorded prior to and one hour after drug administration.

Results—Propranolol caused a reduction in HR (p<0.005), AZBF (p<0.01), and HVPG (p=0.05), but no change in MAP or RBF (454.1 (77.3) versus 413.9 (60.3) ml/min). ISMN reduced MAP (p<0.005) and HVPG (p<0.01), but had no effect on HR, AZBF, or RBF (302.5 (49.4) versus 301.7 (58.8) ml/min). Combined treatment reduced MAP (p<0.005), AZBF (p<0.05), and HVPG (p=0.002), but HR and RBF (419.2 (62.6) versus 415.1 (61.1) ml/min) remained unchanged.

Conclusions—Despite the anticipated changes in other haemodynamic parameters, acute propranolol and/or ISMN administration did not reduce RBF. These drugs do not seem to compromise RBF in cirrhosis.

  • cirrhosis
  • portal hypertension
  • renal blood flow
  • propranolol
  • nitrates

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