Propranolol compared with propranolol plus isosorbide dinitrate in portal‐hypertensive patients: Long‐term hemodynamic and renal effects

The long‐term hemodynamic and renal effects of propranolol were compared with those of propranolol plus isosorbide dinitrate in 44 portal‐hypertensive alcoholic cirrhotic patients. Eight control patients, 8 patients receiving propranolol and 14 patients receiving propranolol plus isosorbide dinitrate were hemodynamically evaluated. Renal function was studied in a fourth group of 14 patients receiving propranolol plus isosorbide dinitrate. Portal pressure decreased more (p < 0.05) with combined therapy (‐21.6%, from 19.5 ± 4.8 to 15.4 ± 4.3 mm Hg) than with propranolol alone (− 12.5%, from 19.9 ± 1.2 to 17.4 ± 1.8 mm Hg). Serum urea and creatinine levels, plasma sodium concentration, urine volume and urinary sodium excretion showed nonsignificant changes in all groups studied. Combined therapy induced a significant (p < 0.05) decrease in plasma renin activity (from 4.42 ± 4.7 to 1.59 ± 1.9 ng/ml/hr) and nonsignificant reductions in plasma aldosterone concentration and creatinine clearance. None of the eight patients with ascites or history of ascites not receiving isosorbide dinitrate showed evidence of impairment in renal sodium metabolism during the study period. In contrast, 8 of the 14 patients (57%) with ascites or history of ascites receiving isosorbide dinitrate showed impairment in renal sodium metabolism (p < 0.01), as reflected by the development or worsening of ascites and the need of higher diuretic requirements. Long‐term combined administration of propranolol plus isosorbide dinitrate is superior to propranolol alone in the pharmacological treatment of portal hypertension. However, the deleterious effects observed in patients with ascites or even with a prior history of ascites preclude recommendation of this therapy for all patients, making it more suitable for patients without advanced liver disease. (HEPATOLOGY 1993;18:477–484.)