EFFECTS OF NIFEDIPINE ON HEPATIC VENOUS-PRESSURE GRADIENT AND PORTAL-VEIN BLOOD-FLOW IN PATIENTS WITH CIRRHOSIS

We investigated the effects of nifedipine on splanchnic haemodynamics in 13 patients with cirrhosis and portal hypertension, and in 10 contr ol subjects using hepatic venous catheterization and pulsed Doppler ul trasound. There were no significant changes in systemic or splanchnic haemodynamics in control patients. In contrast, systemic vasodilatatio n, evidenced by significant decreases in mean arterial pressure and sy stemic vascular resistance, was observed in patients 20 min after subl ingual application of 10 mg nifedipine. Moreover, hepatic venous press ure gradient and portal vein blood flow significantly increased after nifedipine administration. There was a significant correlation between the percentage increases in portal vein blood flow and in hepatic ven ous pressure gradient. However, no correlation was found between the p ercentage change in cardiac output and that in portal vein blood now. Thus the increase in portal vein blood flow appears to be related to s planchnic arterial vasodilatation by nifedipine. Consequently, nifedip ine has deleterious effects on portal haemodynamics in patients with c irrhosis. As nifedipine may potentially increase the risk of variceal haemorrhage in patients with less advanced varices, this drug should b e used with caution in patients with chronic liver disease.