Journul qf Hepcrtology 1991; 21: 284-294 Printed in Denmark All rights resrn~~tl Munksgactrd Copenhugm zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Journal of Hepatology ISSN 0168-8278 Continuous blood pressure monitoring in cirrhosis Relations to splanchnic and systemic haemodynamics Sot-en Moller, Erik Christensen and Jens H. Henriksen Depcrrtments zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA of Clinical Ph.ysiology and Medical Gastroenterolog~~. Hvidovre Hospital and Department qf’ Medicine B, Bispebjerg Hospital, Uniwrsity of Copenhugen, Copenhagen, Denmurk Background/Aims: Low arterial blood pressure is rec- ognised as a distinctive factor in the hyperdynamic circulation in cirrhosis. 24-hour monitoring of the blood pressure and heart rate has recently revealed a reduced circadian variation with relation to liver func- tion. However, associations with other clinical and haemodynamic characteristics have not been investi- gated and the aim of the present study was to identify splanchnic and systemic determinants of the 24-h blood pressure and heart rate in cirrhosis. Methods: The variables were measured by an auto- matic ambulant device for monitoring blood pressure and related to the results of an invasive haemodyn- amic investigation, including measurements of intra- arterial blood pressure (9.00-11.00 h) in 37 patients with cirrhosis. Results: The 24-h blood pressures were significantly lower and the heart rate was significantly higher in patients with cirrhosis than in matched controls (p<O.OWl.OOl). To identify determinants of 24-h or intra-arterial blood pressures and heart rate, pertinent zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHG B ESIDES having portal hypertension, patients with cirrhosis often present with a hyperdynamic circu- lation (1). An important feature in the circulatory alterations is a decreased arterial blood pressure sec- ondary to a marked arteriolar vasodilatation, and compensatory increases in the heart rate (HR), cardiac output, and plasma volume (l-5). The low arterial blood pressure in cirrhotic patients thus reflects the balance between decreased systemic vascular resistance and increased cardiac output (6). We have recently re- Received II December 1996; revised 5 March: accepted I1 Murch 1997 Correspondence: Soren Msller, M.D., Department of Clinical Physiology 239, Hvidovre Hospital, DK-2650 Copenhagen, Denmark. Tel: 45 36 22 74. Fax: 45 36 32 37 50. variables were included in a multivariate regression model. This model revealed that independent determi- nants of a low 24-h arterial blood pressure were a high post-sinusoidal resistance, a low plasma volume, a short central circulation time, and the presence of as- cites. In contrast, a low intra-arterial blood pressure was determined by a low serum sodium, a low haemo- globin, and a high cardiac output. Diuretic treatment did not influence this model. Conclusions: Although the 24-h blood pressure and the intra-arterial blood pressure were determined by different variables, the overall results indicate that ab- normalities in both splanchnic and central haemodyn- amics and sodium-water retention are important in the pathophysiology of arterial hypotension in pa- tients with portal hypertension. Key words: Ambulatory blood pressure monitoring; Central blood volume; Central circulation time; Cir- rhosis; Haemodynamics; Hyperdynamic circulation; Portal hypertension. ported a reduced circadian variation in the blood pressure and HR of cirrhotic patients (7). Surprisingly, their arterial blood pressure was normal at night, but low during the day compared with matched controls (7). The low arterial blood pressure was related to HR and indicators of liver dysfunction, and the abnormal circadian pattern suggested a major defect in the regu- lation of the blood pressure in cirrhotics. Previous studies have indicated an association between the de- gree of systemic hypotension in cirrhosis and the sever- ity of liver dysfunction (7-9), but the relation between the 24-h systemic blood pressure and splanchnic and systemic haemodynamics have not been investigated. As the degree of peripheral vasodilatation and low ar- terial blood pressure may be closely associated with impaired liver function and the degree of portal hyper- 284