Haemodynamic response to intravenous vasopressin and nitroglycerin in portal hypertension

Abstract

We have evaluated the haemodynamic effects of intravenous (iv) nitroglycerin (NG) and vasopressin (VP) alone and in combination, in 12 patients with cirrhosis and recent variceal haemorrhage (two to seven days). Nitroglycerin infusion alone (200 μg/min) produced a significant fall in portal pressure (WHVP-FHVP) (from 16·4 (0·6) to 13·3 (1·2) mmHg; p <0·005). Vasopressin alone (0·4 IU/min) reduced portal pressure (20·7 (1·3) to 14·0 (1·3) mmHg; p<0·001), but there was considerable variation in the systemic haemodynamic changes with increased cardiac output in four of six patients. The combination of vasopressin and nitroglycerin corrected all systemic haemodynamic disturbances produced by either agent alone. This combination led, however, to a further reduction in portal pressure (from 13·7 (0·9) to 11·7 (0·7) mmHg p<0·01). These results show that: (1) intravenous nitroglycerin reduces portal pressure, and (2) the combination of nitroglycerin and vasopressin reverses systemic haemodynamic disturbances produced by either agent alone and leads to a further decrease in portal pressure.