L.B. and A.B. equally contributed to this work and share first authorship.
Low doses of isosorbide mononitrate attenuate the postprandial increase in portal pressure in patients with cirrhosis
Article first published online: 30 DEC 2003
Copyright © 2003 by the American Association for the Study of Liver Diseases
Volume 37, Issue 2, pages 378–384, February 2003
How to Cite
Bellis, L., Berzigotti, A., Abraldes, J. G., Moitinho, E., García-Pagán, J. C., Bosch, J. and Rodés, J. (2003), Low doses of isosorbide mononitrate attenuate the postprandial increase in portal pressure in patients with cirrhosis. Hepatology, 37: 378–384. doi: 10.1053/jhep.2003.50053
- Issue published online: 30 DEC 2003
- Article first published online: 30 DEC 2003
- Manuscript Accepted: 2 NOV 2002
- Manuscript Received: 13 JUN 2002
- Unknown funding agency. Grant Numbers: FIS 00/0444, FIS 01/9356 to J.G.A.
- Fondo de Investigación Sanitaria
Postprandial hyperemia is associated with a significant increase in portal pressure in cirrhosis, which may contribute to progressive dilation and rupture of gastroesophageal varices. In cirrhosis, an insufficient hepatic production of nitric oxide (NO) may impair the expected hepatic vasodilatory response to increased blood flow, further exaggerating the postprandial increase in portal pressure. This study was aimed at investigating whether low doses of an oral NO donor might counteract the postprandial peak in portal pressure. Twenty-three portal hypertensive cirrhotics, 8 of them under propranolol therapy, were randomized to receive orally 5-isosorbide mononitrate (ISMN; 10 mg; n = 11) or placebo (n = 12) and a standard liquid meal 15 minutes later. Hepatic venous pressure gradient (HVPG), mean arterial pressure (MAP), and hepatic blood flow (HBF) were measured at baseline and 15, 30, and 45 minutes after a meal. ISMN significantly attenuated the postprandial increase in portal pressure as compared with placebo (peak HVPG increase: 2.4 ± 1.4 mm Hg vs. 5.2 ± 2.1 mm Hg, P = .002). Percentual increases in HBF were similar in both groups. MAP decreased slightly in ISMN group (−7.5% ± .5%; P < .01 vs. baseline). These effects were also observed in patients on chronic propranolol therapy. In conclusion, hepatic NO supplementation by low doses of ISMN effectively reduces the postprandial increase of portal pressure in cirrhosis, with only a mild effect on arterial pressure. The same was observed in patients receiving propranolol. Our results suggest that therapeutic strategies based on selective hepatic NO delivery may improve the treatment of portal hypertension.