Effect of chronic treatment with nadolol plus isosorbide mononitrate on liver blood flow and liver metabolic activity in cirrhosis

Objective To assess the long-term effect of the addition of long-acting nit rates to beta-blockers on liver blood flow and liver metabolic activity in patients with cirrhosis and portal hypertension. Methods Eleven patients with cirrhosis and portal hypertension were investi gated by using hepatic vein catheterization and indocyanine green (ICG) con stant infusion on baseline conditions, after 1 month of treatment with nado lol, after 3 months of treatment with nadolol plus isosorbide mononitrate, and (in seven cases) after 1 year of combined treatment. Results The hepatic venous pressure gradient decreased significantly after nadolol, and more so after addition of isosorbide mononitrate, Hepatic bloo d flow, and ICG intrinsic hepatic clearance did not change significantly, a lthough few cases showed an increase or decrease in either parameter. A sig nificant correlation was found between changes in ICG intrinsic hepatic cle arance and in hepatic venous pressure gradient (r = 0.62, P = 0.04), Conclusions Liver blood flow and liver metabolic activity are not consisten tly affected by addition of isosorbide mononitrate to nadolol, Substantial decreases in portal pressure may be associated with a decrease in ICG intri nsic hepatic clearance, Eur J Gastroenterol Hepatol 11:1221 - 1225 (C) 1999 Lippincott Williams & Wilkins.