Document Detail

Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture.
MedLine Citation:
PMID:  10207804     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIMS: The aim of this study was to evaluate cardiovascular and renal function in patients with compensated cirrhosis and essential hypertension in the supine position and in response to standing up. METHODS: Twenty-four patients with compensated cirrhosis (12 with elevated arterial pressure) and 20 healthy volunteers underwent echocardiographic evaluation of left ventricular end-diastolic and stroke volumes, ejection fraction, cardiac index, arterial pressure, peripheral resistance, creatinine clearance and sodium excretion in both the supine and the standing position. RESULTS: When supine, only normotensive patients had a hyperdynamic circulation, with increased left ventricular end-diastolic and stroke volumes, cardiac index, and ejection fraction, and reduced peripheral resistance. Creatinine clearance and sodium excretion were comparable in patients and controls. Standing induced a decrease in end-diastolic volume in all subjects. Healthy volunteers maintained cardiovascular homeostasis by increasing ejection fraction and heart rate, while both normotensive and hypertensive cirrhotic patients experienced a fall in stroke volume and cardiac index, despite a marked activation of the renin-aldosterone and sympathetic nervous system. Creatinine clearance decreased only in normotensive patients, who experienced the greatest reduction in sodium excretion. CONCLUSIONS: Compensated cirrhotic patients with arterial hypertension had no evidence of hyperdynamic circulation. Like their normotensive counterparts, hypertensive patients had an impaired cardiovascular response to the postural challenge, but a lesser degree of renal dysfunction during standing.
P Gentilini; R G Romanelli; G Laffi; G Barletta; R Del Bene; G Messeri; G La Villa
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hepatology     Volume:  30     ISSN:  0168-8278     ISO Abbreviation:  J. Hepatol.     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-06-07     Completed Date:  1999-06-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  632-8     Citation Subset:  IM    
Istituto di Medicina Interna, University of Florence School of Medicine, Italy.
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MeSH Terms
Blood Pressure
Creatinine / metabolism*
Esophageal and Gastric Varices / etiology
Heart Rate
Hemodynamics / physiology*
Hypertension / complications,  physiopathology*
Hypertension, Renal / etiology
Kidney Function Tests
Liver Cirrhosis / complications,  physiopathology*
Middle Aged
Multivariate Analysis
Reference Values
Sodium / blood
Stroke Volume
Supine Position
Vascular Resistance
Ventricular Function, Left
Reg. No./Substance:
60-27-5/Creatinine; 7440-23-5/Sodium

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