Cardiovascularand renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture Paolo Gentilini, Roberto Giulio Romanelli, Giacomo LafIi, Giuseppe Barletta’, Riccarda Del Bene’, Gianni Messeri2 and Giorgio La Villa zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQ Istituto di Medicina Interna and ‘Btituto di ClinicrrMedica e Curdiologiu, C’niversit.v of Florence S&o1 qf Medicine und 2Laboratorio di Endocrinologia, Ariendu Ospedulierm Careggi, Florertce Itct!, Buckground’Aims: The aim of this study was to evalu- ate cardiovascular and renal function in patients with compensated cirrhosis and essential hypertension in the supine position and in response to standing up. Methods: Twenty-four patients with compensated cir- rhosis (12 with elevated arterial pressure) and 20 healthy volunteers underwent echocardiographic evaluation of left ventricular end-diastolic and stroke volumes, ejection fraction, cardiac index, arterial pressure, peripheral resistance, creatinine clearance and sodium excretion in both the supine and the standing position. Results: When supine, only normotensive patients had a hyperdynamic circulation, with increased left ven- tricular end-diastolic and stroke volumes, cardiac index, and ejection fraction, and reduced peripheral resistance. Creatinine clearance and sodium excretion were comparable in patients and controls. Standing induced a decrease in end-diastolic volume in all sub- T” CO-EXISTENCE of liver cirrhosis and essential hy- pertension is sometimes found in clinical practice, since both diseases have a high prevalence in middle and late life. Previous studies in large series of cirrhotic patients showed that arterial hypertension occurred in about 10% of them (1,2). It has also been reported that hypertension disappears after the development of cir- rhosis in humans (3,4) and experimental animals (5). However, in the largest study on this topic (6) high blood pressure levels were unaffected by the onset of cirrhosis. Received 20 August: revised 27 October; accepted 3 November 1998 Correspondence: Paolo Gentilini, Istituto di Medicina In- terna, Viale Morgagni 85, 50134 Florence, Italy. Tel: 39 55 416635. Fax 39 55 417123. E-mail: p.gentilini@dfc.unif.it jects. Healthy volunteers maintained cardiovascular homeostasis by increasing ejection fraction and heart rate, while both normotensive and hypertensive cir- rhotic patients experienced a fall in stroke volume and cardiac index, despite a marked activation of the re- nin-aldosterone and sympathetic nervous system. Creatinine clearance decreased only in normotensive patients, who experienced the greatest reduction in so- dium excretion. Conclusions: Compensated cirrhotic patients with ar- terial hypertension had no evidence of hyperdynamic circulation. Like their normotensive counterparts, hy- pertensive patients had an impaired cardiovascular re- sponse to the postural challenge, but a lesser degree of renal dysfunction during standing. Key words: Cirrhosis; Heart; Hypertension; Systemic hemodynamics. Patients with cirrhosis and portal hypertension eventually develop a hyperdynamic circulation, with high cardiac output and reduced systemic vascular re- sistance (SVR). This hemodynamic alteration is thought to be involved in the pathogenesis of sodium retention and ascites (7), which has been observed in 80% of cirrhotic patients after 15 years of disease (8). Whether the hyperdynamic circulation also occurs in cirrhotic patients with arterial hypertension is un- known. Similarly, little information is currently avail- able on the behavior of renal function in the associ- ation of arterial hypertension and cirrhosis. The aim of this study was to evaluate cardiovascular function, systemic hemodynamics, renal function and neuroendocrine factors - the renin-angiotensin-aldo- sterone system (RAAS), the sympathetic nervous sys- tem (SNS) and atria1 natriuretic peptide (ANP) - in 632