Systemic and Portal Hemodynamic Response to Propranolol in Patients with Portal Hypertension Due to Hepatitis C Virus
Objective: Propranolol, a β-adrenergic blocker, has been reported to reduce portal pressure in patients with alcoholic cirrhosis and thereby might be useful in the prophylaxis of variceal bleeding. Since it is not known if the response of patients with portal hypertension due to hepatitis C virus is similar, systemic and portal hemodynamic response to propranolol was evaluated in 10 patients with portal hypertension and hepatitis C virus infection. Methods: Patients were studied before the intravenous infusion of 0.15 mg/kg propranolol, and 30 min after the infusion. Results: Propranolol induced highly significant systemic hemodynamic effects, reducing heart rate from 65 ± 6 to 57 ± 5 (p < 0.0001) and cardiac output from 6.7 ± 1.6 to 5.0 ± 1.1 (liters/min, p < 0.0005). The effect on the pulmonary circulation was a mild increase in diastolic pulmonary artery pressure. Propranolol induced a mild and insignificant decrease in wedged hepatic vein pressure (WHVP), from 32 ± 6 to 29 ± 5 mm Hg, and hepatic venous pressure gradient from 18 ± 3 to 16 ± 5 mm Hg (p > 0.05). Decrease of WHVP of more than 5 mm Hg occurred only in 3 out of 10 patients. Conclusion: It is suggested that propranolol may be useful only in some patients with portal hypertension associated with hepatitis C virus infection.