PROPRANOLOL PLUS PRAZOSIN COMPARED WITH PROPRANOLOL PLUS ISOSORBIDE-5-MONONITRATE IN THE TREATMENT OF PORTAL-HYPERTENSION

Background & Aims: The association of prazosin to propranolol enhances the decrease in portal pressure but may cause hypotension and sodium retention. The aim of this study was to compare the portal pressure re duction and safety of the combination of propranolol plus prazosin wit h that of propranolol plus isosorbide-5-mononitrate (ISMN). Methods: F ifty-six portal-hypertensive cirrhotics received randomly propranolol plus prazosin (n = 28) or propranolol plus ISMN (n = 28) orally for 3 months. Hemodynamics and liver and renal function were assessed at bas eline and after 3 months. Results: Propranolol plus prazosin caused a greater reduction in hepatic venous pressure gradient (HVPG) than prop ranolol plus ISMN (-24.2% +/- 11% vs. -16.1% +/- 11%; P < 0.01). A red uction in HVPG of >20% was significantly more frequent in the proprano lol plus prazosin group than in the propranolol plus ISMN group (85% v s. 53%; P < 0.05). Neither treatment modified hepatic blood flow, quan titative liver function test results, glomerular filtration rate, plas ma renin activity, or plasma aldosterone level. Side effects occurred in 13 patients receiving propranolol plus prazosin compared with 7 rec eiving propranolol plus ISMN (P = 0.16). Conclusions: Propranolol plus prazosin has a greater portal pressure-lowering effect than propranol ol plus ISMN. Both therapies were safe for liver and renal function. H owever, the combination of propranolol plus prazosin caused a greater decrease in arterial pressure and was less well tolerated than propran olol plus ISMN.