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

Background—Propranolol andisosorbide-5-mononitrate (ISMN) are increasingly used in theprophylaxis of variceal haemorrhage in cirrhosis. However, recentstudies have suggested that these drugs may compromise renal function,possibly by reducing renal blood flow.
Aims—To assess the acute effects of propranololand ISMN on renal blood flow and other haemodynamic parameters incirrhosis.
Patients and methods—Twenty six cirrhoticpatients were given either 80 mg propranolol, 20 mg ISMN, or acombination of the two drugs. Unilateral renal blood flow (RBF), azygosblood flow (AZBF), hepatic venous pressure gradient (HVPG), meanarterial 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 orRBF (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 inother haemodynamic parameters, acute propranolol and/or ISMNadministration did not reduce RBF. These drugs do not seem tocompromise RBF in cirrhosis.

Keywords:cirrhosis; portal hypertension; renal blood flow; propranolol; nitrates