Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients

Aims/Background: Cirrhotic patients exhibit a hyperdynamic and hyporeactive circulation with central hypovolaemia which may influence the course of th e disease. As terlipressin, a vasopressin analogue, may modify systemic hae modynamics in these patients, the aim of the present study was to assess th e acute effects of terlipressin on central and systemic haemodynamics. Meth ods: Sixteen patients with alcoholic cirrhosis and portal hypertension had their systemic, central, and splanchnic haemodynamics determined at baselin e and after a blind randomised bolus infusion (2 mg) of terlipressin/placeb o. Results: After terlipressin, the arterial blood pressure and the systemi c vascular resistance increased by 26% and 61%, respectively (both p<0.001) , and the cardiac output, heart rate, and arterial compliance decreased by 18%, 11%, and 32%, respectively (all p<0.001). The central circulation time increased by 36% (p<0.001), whereas the central and arterial blood volume only increased by 4% (p=0.07). As expected, both portal pressure and hepati c blood flow decreased (17% and 29%, both p<0.001). The decrease in portal pressure after terlipressin was significantly related to the increase in sy stemic vascular resistance (r = -0.52, p<0.05) and the central circulation time (r = -0.80, p<0.0001). Conclusions. Terlipressin significantly attenua tes the hyperdynamic circulation in portal hypertensive patients without a further contraction of the central and arterial blood volume. The systemic haemodynamic response to terlipressin is moreover associated with the decre ase in portal pressure. Terlipressin may therefore have potentially benefic ial effects on the hyperdynamic circulation in cirrhosis in addition to its effects on portal pressure.