[Hemodynamic and functional hepatic effects of isosorbide-5-monitrate in cirrhotic patients with portal hypertension].

Isosorbide 5-mononitrate reduces portal pressure in acute conditions. The aim of this work was to assess its effects and tolerance development after 30 days of use in alcoholic cirrhotic patients without history of variceal bleeding. Nine patients with portal hypertension (7 with esophageal varices) were studied. Hepatic and systemic hemodynamic parameters were measured in basal conditions, after one hour and after 30 days of treatment (40 mg b i d). One patient was lost from control at 2 weeks. In the total group, portal pressure decreased from 15.1 +/- 3.7 mm Hg to 12.1 +/- 5 at one hour and 11.3 +/- 5.5 mm Hg at 30 days (p < 0.002). In two patients, portal pressure was not modified. Portal blood flow increased significantly at one hour in the 7 responder patients. Hepatic blood flow (indocyanine green clearance) was not modified; thus, estimated hepatic resistance decreases in both periods. Intrinsic indocyanine green clearance (a measure of hepatic function) did not change in any period. Systemic blood pressure decreased and cardiac rate increased only after one hour. The fall in portal pressure did not correlate with changes in portal or hepatic blood flow. It is concluded that isosorbide 5-mononitrate decreased portal pressure in 7 out of nine patients, even after 30 days of treatment, without untoward effects over hepatic function or perfusion.