Hypertension and liver disease

Abstract

Arterial hypertension is a common disorder with a frequency of 10% to 15% in subjects in the 40- to 60-year age group. Yet most reports find the prevalence of arterial hypertension in patients with chronic liver disease (cirrhosis) much lower. In this review, we consider the alterations in systemic hemodynamics in cirrhosis. The most characteristic findings in cirrhotic patients are vasodilatation with low systemic vascular resistance, increased cardiac output, high arterial compliance, secondary activation of counterregulatory systems (sympathetic nervous system, renin-angiotensin-aldosterone system, neuropituitary release of vasopressin), and resistance to vasopressors. The vasodilatory state is mediated through nitric oxide, calcitonin gene-related peptide, adrenomedullin, and other vasodilators, and is most pronounced in the splanchnic area. This constitutes an effective (although relative) counterbalance to increased arterial blood pressure. Subjects with established arterial hypertension (essential, secondary) may become normotensive during the development of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homeostatic regulation in cirrhotic patients with manifest arterial hypertension. This is a topic for future research.

Coronary Artery Disease in Patients with Liver Cirrhosis

“…We also observed lower arterial blood pressure and cholesterol levels in the cirrhosis group compared to controls. This is in agreement with previous studies showing an effect of liver cirrhosis on arterial blood pressure and cholesterol [9,10]. Furthermore, we found that malnutrition was common among patients with cirrhosis.…”

“…The coagulation abnormalities and thrombocytopenia [3,4], as well as the low serum cholesterol [9] and low arterial blood pressure levels [10] frequently seen in cirrhosis, have been proposed as possible protective factors. Diabetes mellitus, a major risk factor of CAD, has been shown, however, to be common in patients with liver cirrhosis [11], but is also reported not to be associated with cardiovascular disease in this group of patients [12,13].…”

Altered mesenteric venous capacitance and volume pooling in cirrhotic rats are mediated by nitric oxide

“…The ability to mobilize the gut venous reservoir to defend the circulation when needed is mediated through baroreflexes (26,27). Baroreflex function is known to be impaired in cirrhosis (6,14). But the normalization of this homeostatic response in the cirrhotic rat by a selective nNOS inhibitor indicates that NO plays a role in some aspect of baroreflex regulation of gut venomotor responses.…”

Sympathetic Activity, Vascular Capacitance, and Long-Term Regulation of Arterial Pressure

“…For example, portal vein ligation normalizes arterial pressure in spontaneously hypertensive rats49; and the onset of portal hypertension in patients with hepatic cirrhosis and essential hypertension also can produce dramatic decreases in arterial pressure50.…”