Document Detail


Disagreement between acute and chronic haemodynamic effects of nadolol in cirrhosis: a pathophysiological interpretation.
MedLine Citation:
PMID:  16128681     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The acute effects of beta-blockers may be different from chronic; mechanisms underlying this difference are poorly elucidated. AIM: To assess portal pressure and its pathophysiological determinants after acute and chronic administration of nadolol. METHODS: In 24 patients with cirrhosis and portal hypertension hepatic venous pressure gradient, portal blood flow and resistance to portal blood flow were measured before, 60-90 min after acute administration of nadolol, and after 1 month. Patients were good-responders if hepatic venous pressure gradient was < or =12 mmHg, or decreased by at least 20%. RESULTS: Eleven and 13 patients were good- and poor-responders to acute administration, respectively. Acute poor-responders showed a lower decrease in portal blood flow (P = 0.04) and a less evident decrease in mean arterial pressure (P < 0.001). Eleven and 13 patients were good- and poor-responders to chronic administration, respectively. Chronic poor-responders showed a larger increase in resistance to portal blood flow compared with good-responders (P = 0.01). Disagreement between acute and chronic effects was seen in 12 patients: six were acute good-responders chronic poor-responders and six were acute poor-responders chronic good-responders. Acute good-responders chronic poor-responders patients had the smallest decreases in portal blood flow and in mean arterial pressure after acute administration, while acute poor-responders chronic good-responders showed the largest (P = 0.05 and 0.01). CONCLUSIONS: Disagreement between acute and chronic effects of nadolol on hepatic venous pressure gradient is common. The mechanism responsible is complex, the acute effect being mainly modulated by arterial hypotension and the chronic effect by changes in portal resistance.
Authors:
C Merkel; M Bolognesi; D Sacerdoti; G Bombonato; L Cavasin; A Gatta
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  22     ISSN:  0269-2813     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-30     Completed Date:  2005-11-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  433-9     Citation Subset:  IM    
Affiliation:
Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. carlo.merkel@unipd.it
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adrenergic beta-Antagonists / therapeutic use*
Antihypertensive Agents / therapeutic use*
Blood Flow Velocity / drug effects
Blood Pressure / drug effects
Chronic Disease
Female
Heart Rate / drug effects
Hemodynamics / drug effects*
Humans
Hypertension, Portal / drug therapy*
Liver Cirrhosis / drug therapy,  physiopathology*
Male
Middle Aged
Nadolol / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 42200-33-9/Nadolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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