EFFECTS OF PROPRANOLOL ON THE HEPATIC HEMODYNAMIC-RESPONSE TO PHYSICAL EXERCISE IN PATIENTS WITH CIRRHOSIS

Physical exercise increases portal pressure (hepatic venous pressure g radient [HVPG]) in patients with cirrhosis. It is unknown if this dele terious effect is associated with changes in gastroesophageal collater al blood flow and if these can be prevented by propranolol administrat ion. The aim of this study was to characterize the effects of proprano lol on the splanchnic hemodynamic response to exercise in patients wit h cirrhosis, Twenty-three patients with cirrhosis and portal hypertens ion had hemodynamic measurements in baseline conditions, and during mo derate cycling exercise (40 W) under double-blind propranolol or place bo administration. In patients receiving placebo, HVPG significantly i ncreased during exercise (from 16.7 +/- 0.9 to 19.0 +/- 1.0 mm Hg; P < .01), hepatic blood flow (HBF) decreased (-18% +/- 4%; P < .01), whil e azygos blood flow (AzBF) was unchanged (4% +/- 12%; ns). In patients receiving propranolol, portal pressure did not increase during exerci se, but decreased from 16.3 +/- 1.0 to 12.9 +/- 1.1 mm Hg (P < .01), T he lack of increase in HVPG in response to exercise in patients receiv ing propranolol may be related to a more pronounced decrease in HBF, a s compared with patients receiving placebo, and to a blunted increase in cardiac output (CO), Moderate physical exercise adversely influence s the hepatic hemodynamics in patients with cirrhosis, causing a signi ficant increase in portal pressure. This is effectively prevented by p ropranolol pretreatment.