The effect of the combination of nitroglycerin and propranolol on splanchnic and systemic hemodynamics in a portal hypertensive rat model

Authors

  • Richard J. Kroeger,

    1. Hepatic Hemodynamics Laboratory, Veterans Administration Medical Center, West Haven, Connecticut 06516 and Yale University School of Medicine, New Haven, Connecticut 06510
    Search for more papers by this author
  • Roberto J. Groszmann M. D.

    Corresponding author
    1. Hepatic Hemodynamics Laboratory, Veterans Administration Medical Center, West Haven, Connecticut 06516 and Yale University School of Medicine, New Haven, Connecticut 06510
    • Medical Service/151, Veterans Administration Medical Center, West Haven, Connecticut 06516
    Search for more papers by this author

Abstract

Present investigations support major contributions from increases in both portal blood flow and portal vascular resistance in the mechanism that maintains portal hypertension. β-Adrenergic blockers have been shown to reduce the elevated portal blood flow component. The possibility that nitroglycerin administration could reduce the elevated portal vascular resistance component is investigated here. Portal hypertension was induced in rats by a calibrated constriction of the portal vein. Portal hypertensive rats receiving placebo exhibited significant (p < 0.05) elevations over normal rats receiving placebo in cardiac index, portal venous inflow and portal pressure. Portal hypertensive rats were then divided into groups receiving nitroglycerin infusion, propranolol (β-adrenergic blockade) and combined administration of nitroglycerin and propranolol. Significant reductions (p < 0.05) in portal blood flow of 30, 32 and 44%, respectively, were accompanied by significant portal pressure reductions of 2.7 ± 0.2, 1.7 ± 0.3 and 3.6 ± 0.4 mm Hg in all groups, respectively (p < 0.05). Nitroglycerin failed to prevent a 46% rise in portal-collateral resistance accompanying the portal blood flow reduction, similar to resistance rises also found in propranolol-treated (33%) and combination nitroglycerin-propranolol-treated (49%) groups. We conclude that nitroglycerin infusion can significantly reduce portal pressure, alone or in combination with β-blockade, by reducing portal venous inflow. It appears that nitroglycerin reduces portal blood flow through the effect of baroreceptor sympathetic reflexes that constrict the splanchnic bed in response to vasodilatation and venous pooling.

Ancillary