Portal venous flow in response to acute β-blocker and vasodilatatory treatment in patients with liver cirrhosis

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Abstract
The drugs currently under investigation in the prevention of recurrent gastrointestinal bleeding in cirrhosis are likely to decrease the portal pressure by means of a primary reduction of portal blood flow. The hemodynamic effects of β-blocking agents and vasodilatory drugs were noninvasively measured in eight patients with cirrhosis by means of pulsed echo-doppler equipment. Portal caliber, blood velocity and flow were recorded hourly after a single dose of propranolol (40 mg p.o.) or atenolol (100 mg p.o.), and every 5 min after treatment with isosorbide dinitrate (5 mg sublingually). The drugs were administered at random with an interval of 2 days or more. The portal caliber decreased after atenolol, but did not change after propranolol and isosorbide. The blood velocity decreased by 29 ± 2% 3 hr after propranolol, by 26 ± 2% 3 hr after atenolol and by 31 ± 3% 15 min after isosorbide. The portal blood flow decreased by 0.29 ± 0.03 liters per min after propranolol, by 0.34 ± 0.06 after atenolol and by 0.26 ± 0.03 after isosorbide, without any difference among the various treatments. β-blockers and vasodilatory drugs have comparable effects on portal blood flow. β1-selective and nonselective β-blockers are similarly effective in keeping with the hypothesis that changes in portal blood flow are mainly due to the block of β1-receptors.