CONTINUOUS PRAZOSIN ADMINISTRATION IN CIRRHOTIC-PATIENTS - EFFECTS ONPORTAL HEMODYNAMICS AND ON LIVER AND RENAL-FUNCTION

Background & Aims: Hepatic vascular resistance is influenced by alpha- adrenergic tone. The aim of this study was to investigate the effects of continuous blockade of alpha-adrenoceptors with prazosin on hemodyn amics, liver function, and renal function and whether the association of propranolol or furosemide enhances the portal pressure lowering eff ect of prazosin. Methods: Cirrhotic patients with portal hypertension were studied at baseline and after a 3-month course of prazosin (n = 1 8) or placebo (n = 10). Results: No changes were observed in the place bo group. Prazosin decreased the hepatic venous pressure gradient (HVP G) while increasing hepatic blood flow. Liver function improved as sho wn by an increase in hepatic and intrinsic hepatic clearances of indoc yanine green and galactose elimination capacity. A significant reducti on in mean arterial pressure and systemic vascular resistance was asso ciated with increases in plasma renin activity and aldosterone concent ration and a decrease in glomerular filtration rate. The plasma volume increased significantly, and 6 patients developed edema. The associat ion of propranolol (n = 8) but not furosemide (n = 7) to prazosin incr eased the reduction in HVPG and attenuated the increase in plasma reni n activity. Conclusions: In cirrhotic patients, continuous prazosin ad ministration reduces portal pressure and improves liver perfusion and function but favors sodium and water retention. The association of pro pranolol enhances the decrease in portal pressure, suggesting a potent ial benefit from this combined therapy.