Nitroglycerin improves the hemodynamic response to vasopressin in portal hypertension

Authors

  • Dr. Roberto J. Groszmann M.D.,

    Corresponding author
    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    • Veterans Administration Medical Center (111E), West Spring Street, West Haven, Connecticut 06516
    Search for more papers by this author
    • Dr. Groszmann is a recipient of a Public Health Service Career Development Award 5 K04-AM00670.

  • David Kravetz,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • Jaime Bosch,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • Mortom Glickman,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • Jordi Bruix,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • James Bredfeldt,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • Harold O. Conn,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • Juan Rodes,

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author
  • Edward H. Storer

    1. Departments of Medicine, Surgery, and Radiology, Veterans Administration Medical Center, West Haven, Connecticut 06516
    2. Yale University School of Medicine, New Haven, Connecticut 06520
    3. Liver Unit, Hospital Clinico y Provincial, University of Barcelona School of Medicine, Barcelona, Spain
    Search for more papers by this author

Abstract

This study was designed to investigate whether the addition of nitroglycerin to vasopressin infusion could avoid the deleterious systemic effects of vasopressin while maintaining or enhancing the therapeutic benefits of portal pressure reduction. The effect of nitroglycerin on splanchnic and systemic hemodynamics was studied in cirrhotic patients and portal hypertensive dogs receiving i.v. vasopressin. During i.v. vasopressin infusion (0.4 units per min), the cardiac output decreased in patients by 14% from 7.6 ± 0.9 (mean ± S.E.) to 6.5 ± 0.7 liters per min, p < 0.01, the mean arterial pressure increased 21% from 87 ± 2 to 105 ± 4, p < 0.01, and the heart rate decreased 11% from 79 ± 3 to 71 ± 3, p < 0.01. The administration of sublingual nitroglycerin (0.4 mg) returned all the systemic hemodynamic parameters to baseline values. In dogs, vasopressin infusion significantly reduced portal pressure and flow while increasing portal venous resistance. Nitroglycerin when added to the vasopressin infusion reduced portal venous resistance and further decreased portal pressure in dogs. In patients, vasopressin reduced the hepatic blood flow (44%), wedged hepatic venous pressure (11%), and the gradient between wedged and free hepatic venous pressures (23%). Nitroglycerin administration caused a further reduction of the wedged hepatic venous pressure (23.6 ± 2.3 to 21.1 ± 2.0, 11%, p < 0.01). There was a small but not significant further decline (7%) in the hepatic venous pressure gradient. These results provide evidence that the addition of nitroglycerin to an i.v. infusion of vasopressin reversed the detrimental effects of vasopressin while preserving the beneficial effects.

Ancillary