ACUTE EFFECT OF PROPRANOLOL AND ISOSORBIDE-5-MONONITRATE ADMINISTRATION ON RENAL BLOOD-FLOW IN CIRRHOTIC-PATIENTS

Background-Propranolol and isosorbide-5-mononitrate (ISMN) are increas ingly used in the prophylaxis of variceal haemorrhage in cirrhosis, Ho wever, recent studies have suggested that these drugs may compromise r enal function, possibly by reducing renal blood flow. Aims-To assess t he acute effects of propranolol and ISMN on renal blood flow and ether haemodynamic parameters in cirrhosis. Patients and methods-Twenty six cirrhotic patients were given either 80 mg propranolol, 20 mg ISMN, o r a combination of the two drugs. Unilateral renal blood flow (PBF), a zygos blood flow (AZBF), hepatic venous pressure gradient (HVPG), mean arterial pressure (MAP), and heart rate (HR) were recorded prior to a nd one hour after drug administration. Results-Propranolol caused a re duction in HR (p<0.005), AZBF (p<0.01), and HVPG (p=0.01), but no chan ge in MAP or RBF (454.1 (77.3) versus 413.9 (60.3) ml/min). ISMN reduc ed MAP (p<0.005) and HVPG (p<0.01), but had no effect an HR, AZBF, or PPP (302.5 (49.4) versus 301.7 (58.8) ml/min). Combined treatment redu ced MAP (p<0.005), AZBF (p<0.05), and HVPG (p=0.002), but HR and RBF ( 419.2 (62.6) versus 415.1 (61.1) ml/min) remained unchanged. Conclusio ns-Despite the anticipated changes in other haemodynamic parameters, a cute propranolol and/or ISMN administration did not reduce PPP These d rugs do not seem to compromise RBF in cirrhosis.