Effects of treatment with β-blocker and aldosterone antagonist on central and peripheral haemodynamics and oxygenation in cirrhosis

Objectives Patients with cirrhosis often exhibit abnormalities in cardiovascular regulation and oxygenation. Many of these patients are treated with beta-blockers and aldosterone antagonists that may influence the regulation of systemic haemodynamics, but the specific effects on systemic haemodynamics and oxygenation are less studied. We therefore investigated systemic haemodynamics and oxygenation in patients with cirrhosis before and after 3 weeks of treatment with propranolol or spironolactone. Materials and methods Twenty-two patients with cirrhosis were allocated into three groups as follows: a beta-blocker group (n=7), a spironolactone group (n=8) and a control group (n=7). At baseline, and after 3 weeks, we measured the arterial blood pressure (BP), heart rate, Q-T frequency-corrected interval, baroreflex sensitivity, cardiac output, peripheral arterial inflow (ABF(in)), transcutaneous oxygenation and hormonal status. We also assessed immediate effects of propranolol in the beta-blocker group. Results Short-term and long-term beta-blockade significantly reduced BP (-7%) and heart rate (-15%) (P<0.01). Short-term beta-blocker treatment improved the Q-T frequency-corrected interval but reduced the transcutaneous oxygenation (P<0.05). Baroreflex sensitivity and brain natriuretic peptide increased after short-term and after 3 weeks of beta-blocker treatments (P<0.01). After 3 weeks, beta-blockers reduced cardiac output and ABF(in) by 13 and 26%, respectively (P<0.05-0.01). In the spironolactone group, BP decreased by 8% (P<0.05) and renin increased by 370% (P<0.01). No changes were seen in the control group. Conclusion Short-term and long-term treatments with beta-blockers and aldosterone antagonist modestly affect haemodynamics and oxygenation. Careful monitoring, especially in patients with low arterial blood pressure, if cardiac dysfunction is suspected, should follow the administration of beta-blockers. Eur J Gastroenterol Hepatol 23:334-342 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.