Oral Administration of Nipradilol and the Acute and Chronic Splanchnic Hemodynamic Effects of a New β-Blocker with Nitrovasodilating Properties in Patients with Liver Cirrhosis

Objectives: We studied the effects of nipradilol, which has both a nonselective β-blocker action and a vasodilating action similar to nitroglycerin, on portal hypertension. Methods: We measured hepatic venous pressure gradient and splanchnic and systemic hemodynamics before beginning therapy, 2 h after an oral dose of 6 mg, and after either 6 months of nipradilol 6 mg twice a day (n = 14) or of a placebo (n = 6) in 20 cirrbotic patients. Results: No significant changes were observed after the administration of the placebo. Oral nipradilol induced a significant reduction in the hepatic venous pressure gradient (base line: 14.8 ± 3.2 mm Hg vs 2 h: 12.3 ± 3.4 mm Hg, p < 0.01; 6 mo: 12.5 ± 3.2 mm Hg, p < 0.05) without a significant change in the free hepatic venous pressure. The hepatic vascular resistance decreased signifi-cantly (base line: 1811 ± 778 dyn. sec. cm^-5 vs 2 h: 1540 ± 701 dyn. scc. cm^-5, p < 0.05; 6 mo: 1564 ± 693 dyn. sec. cm^-5, p < 0.05) without a significant change in hepatic blood flow. A decrease in the hepatic venous pressure gradient greater than 10% was observed in nine patients (64%), defined as "responders," at 2 h and in 10 patients (71%) at 6 months. The reduction of mean heart rate and hepatic venous pressure gradient in these responders was 16.2% and 28.3% at 2 h and 15.1% and 27.1% at 6 months, respectively. Conclusions: We found that in some cirrhotic patients, at the doses used in this study, long term oral nipradilol administration produces a reduction in the hepatic venous pressure gradient with both a β-blocking and a nitrovasodilating action.