Haemodynamic assessment and therapeutic studies in portal hypertension and ascites

• Main Author: Stanley, Adrian John
• Published: University of Edinburgh 1998
• Subjects: 615.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.662359

Portal, systemic, cardiopulmonary and renal haemodynamics of 96 patients with alcohol related cirrhosis were measured. Their inter-relationship and predictive value for variceal haemorrhage and survival during a mean follow-up of 19 months was investigated. Severity of liver disease was related to the hepatic venous pressure gradient (HVPG), azgos blood flow (AzBF) and systemic hypotension. During follow-up, HVPG predicted survival and variceal bleeding. Propranolol and isosorbide-5-mononitrate are widely used in the prophylaxis of variceal haemorrhage, but recent reports have suggested they may compromise renal function. Renal blood flow (RBF), HVPG, AzBF and systemic haemodynamics were measured in 26 cirrhotic patients before and after each drug or combination therapy. Despite significant changes in the other parameters, no fall in RBF was detected. The novel vasodilating beta-blocker carvedilol offers potential in the treatment of portal hypertension, but little data currently exist. Portal, cardiopulmonary and systemic haemodynamics and renal function were assessed in 17 cirrhotic patients after acute and chronic (1 month) therapy. Although carvedilol had a continued portal hypotensive effect after 1 month with no detrimental effect on liver blood flow or renal function, a significant minority of patients were unable to tolerate chronic therapy. Adenosine-antagonism offers a new therapeutic approach to cirrhotic ascites and renal dysfunction. The effects on renal and systemic haemodynamics and renal function were assessed following administration of FK352 (a novel adenosine-1 antagonist) to 12 cirrhotic patients with ascites. An improvement in natriuresis, diuresis and RBF was detected.