Propranolol compared with propranolol plus isosorbide-5-mononitrate for portal hypertension in cirrhosis

In cirrhosis of the liver, much of the normal liver tissue is replaced by fibrous scar tissue, which can compress blood vessels and interfere with blood flow through the liver, causing congestion. This congestion can cause back pressure on the blood vessels that empty into the liver's circulation, enlarging these other blood vessels. When the veins of the esophagus are engorged as a result of cirrhosis, they are known as varices, and are prone to profuse bleeding, which is often fatal. In recent years, the drug propranolol, which is frequently used for high blood pressure, has been recognized to reduce the pressures in the circulation of the liver (known as the portal circulation). Whether other drugs, alone or in combination with propranolol, can further reduce portal pressures is unknown. A study was done comparing 21 patients with cirrhosis who were taking propranolol alone to 21 who were given propranolol and isosorbide-5-mononitrate (Is-5-Mn), an oral form of nitroglycerine. The combination regimen reduced the pressures in the portal circulation far more than propranolol alone. Theoretically, this reduction in the pressures in the portal system should cause less back pressure in other areas of the circulation, and should reduce the incidence of bleeding from esophageal varices, making the combination therapy an attractive alternative. Further, the combination of propranolol and Is-5-Mn did not cause some of the adverse effects occasionally seen with propranolol alone, such as a decrease in the amount of blood flow to the liver, or a decline in the function of the liver. Further studies are warranted to determine if the theoretical benefits the results of this study indicates are of clinical importance. (Consumer Summary produced by Reliance Medical Information, Inc.)