Effects of low-sodium diet and spironolactone on portal pressure in patients with compensated cirrhosis†

García‐Pagán, Juan Carlos; Salmerón, Juan Manuel; Feu, Faust; Luca, Angelo; Ginès, Pere; Pizcueta, Pilar; Clariá, J. J.; Piera, Carlos; Arroyo, Vicente; Bosch, Jaume; Rodés, Juan

doi:10.1002/hep.1840190506

Cited by 106 publications

(53 citation statements)

References 23 publications

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“…10,11 However, a correlation could not be shown between the decrease in circulating plasma volume and the decrease in HVPG. 5,6,8 It has been suggested that spironolactone may also have a direct vasoactive effect on the splanchnic circulation that is not mediated by its antialdosteronic mechanism. 12 Abbreviations: HVPG, hepatic venous pressure gradient; N ϩ P, nadolol plus placebo; N ϩ S, nadolol plus spironolactone.…”

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confidence: 99%

“…4 Recent data have shown that spironolactone significantly lowers portal and variceal pressures by reducing plasma volume and splanchnic blood flow. [5][6][7][8][9] Plasma volume depletion improves the hyperdynamic circulatory state associated with the development and maintenance of portal hypertension. 10,11 However, a correlation could not be shown between the decrease in circulating plasma volume and the decrease in HVPG.…”

mentioning

confidence: 99%

“…10,11 However, a correlation could not be shown between the decrease in circulating plasma volume and the decrease in HVPG. 5,6,8 It has been suggested that spironolactone may also have a direct vasoactive effect on the splanchnic circulation that is not mediated by its antialdosteronic mechanism. 12 The decrease in portal pressure achieved by administration of spironolactone could be found even in patients without ascites [5][6][7] and with or without a restricted sodium diet.…”

mentioning

confidence: 99%

“…5,6,8 It has been suggested that spironolactone may also have a direct vasoactive effect on the splanchnic circulation that is not mediated by its antialdosteronic mechanism. 12 The decrease in portal pressure achieved by administration of spironolactone could be found even in patients without ascites [5][6][7] and with or without a restricted sodium diet. [6][7][8] The acute addition of intravenous propranolol to long-term spironolactone therapy (100 mg/d) further decreased HVPG.…”

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confidence: 99%

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Nadolol plus spironolactone in the prophylaxis of first variceal bleed in nonascitic cirrhotic patients: A preliminary study

Abecasis¹

2003

Hepatology

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Treatment with ␤-blockers fails to decrease portal pressure in nearly 40% of cirrhotic patients. Recent studies have suggested that treatment with spironolactone reduces pressure and flow in the portal and variceal systems. This trial was designed to assess if nadolol plus spironolactone is more effective than nadolol alone to prevent the first variceal bleeding. One hundred patients with medium and large varices who had never bled and were without ascites were included in a prospective, randomized, multicenter, double-blind, placebo-controlled trial. The patients were randomized into 2 groups: 51 received nadolol plus placebo (N ؉ P) and 49 received nadolol plus spironolactone 100 mg/d (N ؉ S). Hepatic venous pressure gradient (HVPG) and activity of the renin-aldosterone system (plasma renin activity/plasma aldosterone levels) were measured in 24 patients. There were no significant differences in the appearance of variceal bleeding and ascites between groups at a mean follow-up of 22 ؎ 16 months. However, analyzing both complications together, the incidence was significantly higher in the N ؉ P group than in the N ؉ S group (39% vs. 20%; P < .04). Clinical ascites was also higher in patients in the N ؉ P group than in the N ؉ S group (21% vs. 6%; P < .04). Significant increases in plasma renin activity and plasma aldosterone levels were only observed in patients in the N ؉ S group (P < .01). The cumulative probabilities of remaining free of bleeding and ascites were similar in both groups after 70 months of follow-up. In conclusion, these results suggest that nadolol plus spironolactone does not increase the efficacy of nadolol alone in the prophylaxis of the first variceal bleeding. However, when bleeding and ascites were considered together, the combined therapy effectively reduced the incidence of both portal-hypertensive complications. A t present, nonselective ␤-adrenergic blockers (␤-blockers) are the drugs of choice to prevent the first variceal bleeding in cirrhotic patients with large esophageal varices. 1 Previous studies have shown that reduction of the hepatic venous pressure gradient (HVPG) to less than 12 mm Hg or a decrease in HVPG greater than 20% from basal values protects against variceal hemorrhage. However, such a decrease in portal pressure could be achieved in only 20% of patients receiving ␤-blockers. 2 Moreover, 40% of treated patients do not have reduced portal pressure despite adequate ␤-blockade. 3 Therefore, the addition of drugs to ␤-blockers has been investigated to achieve effective reductions in portal pressure in a greater proportion of patients. 4 Recent data have shown that spironolactone significantly lowers portal and variceal pressures by reducing plasma volume and splanchnic blood flow. 5-9 Plasma volume depletion improves the hyperdynamic circulatory state associated with the development and maintenance of portal hypertension. 10,11 However, a correlation could not be shown between the decrease in circulating plasma volume and the decrease in HVPG. 5,6,8 It has been sugge...

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mentioning

confidence: 99%

mentioning

confidence: 99%

“…10,11 However, a correlation could not be shown between the decrease in circulating plasma volume and the decrease in HVPG. 5,6,8 It has been suggested that spironolactone may also have a direct vasoactive effect on the splanchnic circulation that is not mediated by its antialdosteronic mechanism. 12 The decrease in portal pressure achieved by administration of spironolactone could be found even in patients without ascites [5][6][7] and with or without a restricted sodium diet.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Nadolol plus spironolactone in the prophylaxis of first variceal bleed in nonascitic cirrhotic patients: A preliminary study

Abecasis¹

2003

Hepatology

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“…In monotherapy, it was shown to improve hyperdynamic circulation and to decrease circulating plasma volume and portal pressure, but the exact relationship among these actions is still unclear. 8,[26][27][28] In patients unresponsive to propranolol alone, the addition of spironolactone significantly reduced variceal pressure. 8 However, in that study some patients were treated with insufficient doses of propranolol.…”

mentioning

confidence: 99%