Effect of beta-adrenergic blockade on elevated arterial compliance and lowsystemic vascular resistance in cirrhosis

Background: Patients with cirrhosis exhibit a characteristic hyperdynamic c irculation with increased cardiac output and heart rate and reduced systemi c vascular resistance. The compliance of the arterial tree has recently bee n reported to be increased in these patients, who are often treated with be ta-blockers, but the effect of this treatment on arterial compliance has no t been investigated. The aim of the present study was therefore to assess t he effects of propranolol on the arterial compliance of patients with cirrh osis. Methods: Twenty patients with cirrhosis underwent a haemodynamic inve stigation with determination of splanchnic and systemic haemodynamics. Arte rial compliance was determined as the ratio of the stroke volume to the pul se pressure and compared to normal values. Results: All the patients had si gnificant portal hypertension, with a mean hepatic venous pressure gradient (HVPG) of 17.8 mmHg, and responded to beta-blocker treatment with a signif icant reduction in the HVPG (-16%; P < 0.001). Arterial compliance was elev ated (1.27 versus controls 1.01 ml/mmHg: P < 0.001), but remained almost un changed during beta-adrenergic blockade (1.27 versus 1.29 ml/mmHg, + 2%, ns ), whereas systemic vascular resistance increased substantially (1083 versu s 1378 dyn x s x cm(-5), + 27%; P < 0.001). The mean arterial blood pressur e (-6%; P < 0.05), heart rate (-20%: P < 0.001), cardiac output (-25%: P < 0.001) and hepatic blood Row (-22%; P < 0.001) fell significantly. Conclusi ons: Treatment with beta-blockers increases small vessel (arteriolar) vascu lar tone towards the normal level, but does not affect the elevated complia nce of the larger arteries in patients with cirrhosis.