PROPRANOLOL COMPARED WITH PROPRANOLOL PLUS ISOSORBIDE DINITRATE IN PORTAL-HYPERTENSIVE PATIENTS - LONG-TERM HEMODYNAMIC AND RENAL EFFECTS

The long-term hemodynamic and renal effects of propranolol were compar ed with those of propranolol plus isosorbide dinitrate in 44 portal-hy pertensive alcoholic cirrhotic patients. Eight control patients, 8 pat ients receiving propranolol and 14 patients receiving propranolol plus isosorbide dinitrate were hemodynamically evaluated. Renal function w as studied in a fourth group of 14 patients receiving propranolol plus isosorbide dinitrate. Portal pressure decreased more (p < 0.05) with combined therapy (-21.6%, from 19.5 +/- 4.8 to 15.4 +/- 4.3 mm Hg) tha n with propranolol alone (-12.5%, from 19.9 +/- 1.2 to 17.4 +/- 1.8 mm Hg). Serum urea and creatinine levels, plasma sodium concentration, u rine volume and urinary sodium excretion showed nonsignificant changes in all groups studied. Combined therapy induced a significant (p < 0. 05) decrease in plasma renin activity (from 4.42 +/- 4.7 to 1.59 +/- 1 .9 ng/ml/hr) and nonsignificant reductions in plasma aldosterone conce ntration and creatinine clearance. None of the eight patients with asc ites or history of ascites not receiving isosorbide dinitrate showed e vidence of impairment in renal sodium metabolism during the study peri od. In contrast, 8 of the 14 patients (57%) with ascites or history of ascites receiving isosorbide dinitrate showed impairment in renal sod ium metabolism (p < 0.01), as reflected by the development or worsenin g of ascites and the need of higher diuretic requirements. Long-term c ombined administration of propranolol plus isosorbide dinitrate is sup erior to propranolol alone in the pharmacological treatment of portal hypertension. However, the deleterious effects observed in patients wi th ascites or even with a prior history of ascites preclude recommenda tion of this therapy for all patients, making it more suitable for pat ients without advanced liver disease.