Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture
Section snippets
Subjects
The study was performed in 20 healthy volunteers (10 men, mean age (±SD) 60±7, range 47–73 years) and 24 inpatients with compensated cirrhosis and portal hypertension, as indicated by the presence of esophageal varices at endoscopy. Twelve patients (6 males, mean age 58±6, range 47–71 years) had normal arterial pressure, while the remaining 12 (3 males, mean age 62±8, range 49–73 years) had stage 1–2 essential hypertension, according to the VIth report of the Joint National Committee on
Results
The clinical characteristics of the 20 healthy volunteers and 24 cirrhotic patients included in the study are shown in Table 1. UNaV ranged between 90 and 110 mmol/day in all subjects, confirming adherence to the diet. In-hospital systolic and diastolic arterial pressure was: 126±10 over 75±6 mmHg in healthy subjects, 125±13 over 74±7 mmHg in normotensive and 159±13 over 95±7 mmHg in hypertensive cirrhotic patients. A close relationship was found between in-hospital arterial pressure and blood
Cardiac function and systemic hemodynamics
Results of echocardiographic measurements are shown in TABLE 2, TABLE 3. Cirrhotic patients with essential hypertension had the highest LVMI. Relative wall thickness was also higher in this group than in healthy subjects and normotensive cirrhotic patients. In the supine position, normotensive cirrhotic patients had significantly greater CI and lower SVR than healthy subjects and hypertensive cirrhotic patients, no appreciable differences being observed between the latter two groups of subjects
Renal function
No appreciable differences were observed among the three groups of subjects included in the study with respect to supine measurements of creatinine clearance, UNaV and urine flow rate (Table 4). UNaV and urine flow rate decreased during standing in all groups, whereas creatinine clearance decreased only in normotensive cirrhotic patients. Values of urine flow rate observed in hypertensive cirrhotic patients during standing were significantly lower than those of healthy subjects.
Endocrine parameters
Results of endocrine measurements are listed in Table 5. When supine, normotensive cirrhotic patients showed significantly higher plasma ANP levels than healthy subjects and hypertensive patients with cirrhosis. No differences were observed among the three groups of subjects included in the study with respect to the other endocrine parameters measured in the supine position. In the supine position, PAC level significantly correlated with CI (r=0.505, pr=0.35, p=0.029 for SVRI). In cirrhotic
Discussion
When evaluated in the supine position, normotensive patients with compensated cirrhosis had hyperdynamic circulation, as indicated by high cardiac output and reduced SVR. The increased cardiac output was due to both an increased preload and a reduced afterload. In fact, they had a higher LVEDVI, an indicator of left ventricular filling and thus of venous return (20), and also a reduction of the SVI/PP ratio, an approximate measure of arterial compliance 21., 22., pointing to a reduced
Acknowledgements
Supported by grants from the Italian Ministero per l'Università e la Ricerca Scientifica e Tecnologica and the Italian Liver Foundation (1996).
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