Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture

Background/Aims: The aim of this study was to evaluate cardiovascular and r enal function in patients with compensated cirrhosis and essential hyperten sion in the supine position and in response to standing up. Methods: Twenty-four patients with compensated cirrhosis (12 with elevated arterial pressure) and 20 healthy volunteers under,vent echocardiographic e valuation of left ventricular end-diastolic and stroke volumes, ejection fr action, cardiac index, arterial pressure, peripheral resistance, creatinine clearance and sodium excretion in both the supine and the standing positio n. Results: When supine, only normotensive patients had a hyperdynamic circula tion, with increased left ventricular end-diastolic and stroke volumes, car diac index, and ejection fraction, and reduced peripheral resistance. Creat inine clearance and sodium excretion were comparable in patients and contro ls, Standing induced a decrease in end-diastolic volume in all subjects. He althy volunteers maintained cardiovascular homeostasis by increasing ejecti on fraction and heart rate, while both normotensive and hypertensive cirrho tic patients experienced a fall in stroke volume and cardiac index, despite a marked activation of the renin-aldosterone and sympathetic nervous syste m. Creatinine clearance decreased only in normotensive patients, who experi enced the greatest reduction in sodium excretion. Conclusions: Compensated cirrhotic patients with arterial hypertension had no evidence of hyperdynamic circulation. Like their normotensive counterpar ts, hypertensive patients had. an impaired cardiovascular response to the p ostural challenge, but a lesser degree of renal dysfunction during standing .