Long-Term Effects of Oral Propranolol on Splanchnic and Systemic Haemodynamics in Patients with Cirrhosis and Oesophageal Varices

Abstract

Splanchnic and systemic haemodynamics were measured in 24 patients with cirrhosis and oesophageal varices and no previous bleeding. The patients were randomized either to long-term treatment with propranolol (14 patients) or no active treatment (controls, 10 patients). Catheterization was performed again 1 year after randomization. After 1 year of treatment the hepatic venous pressure gradient had decreased in both the propranolol and control group (−16% versus -24% (NS), respectively). Hepatic blood flow decreased substantially in both groups but significantly more in the propranolol group (−39% versus -17% (p < 0.05), respectively). Azygos blood flow was significantly reduced after 1 year in the propranolol group (−47%, n = 5 (p < 0.05)), and no obvious effect was observed in the control group (−2%, n = 4). The cardiac index decreased significantly in the propranolol group but not in the control group (−20% versus -1% (p < 0.05), respectively). Our results demonstrate that the splanchnic hyperdynamic condition observed in cirrhosis is in some of the patients partly reversible without pharmacologic treatment. No additional effect of propranolol was observed on portal pressure after 1 year of treatment with propranolol, whereas a decrease in azygos blood flow was observed only in the propranolol group. The beneficial effect of propranolol on the risk of bleeding from oesophageal varices may, therefore, mostly be due to a selective decrease in collateral blood flow and thereby variceal blood flow.

Key Words:

• Cirrhosis
• long-term
• propranolol
• splanchnic haemodynamics