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World J Gastroenterol. Nov 28, 2008; 14(44): 6824-6830
Published online Nov 28, 2008. doi: 10.3748/wjg.14.6824
Effect of propranolol on the splanchnic and peripheral renin angiotensin system in cirrhotic patients
Walkíria Wingester Vilas-Boas, Antônio Ribeiro-Oliveira Jr, Renata da Cunha Ribeiro, Renata Lúcia Pereira Vieira, Jerusa Almeida, Ana Paula Nadu, Ana Cristina Simões e Silva, Robson Augusto Souza Santos
Walkíria Wingester Vilas-Boas, Renata Lúcia Pereira Vieira, Jerusa Almeida, Ana Paula Nadu, Robson Augusto Souza Santos, Laboratório de Hipertensão, Departamento de Fisiologia e Biofísica, ICB-UFMG, Av. Antonio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil
Antônio Ribeiro-Oliveira Jr, Renata da Cunha Ribeiro, Laboratório de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina-UFMG, Av. Alfredo Balena, 190, Belo Horizonte, MG, 30130-100, Brazil
Ana Cristina Simões e Silva, Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av. Alfredo Balena, 190, Belo Horizonte, MG, 30130-100, Brazil
Author contributions: Vilas-Boas WW, Ribeiro-Oliveira Jr A, Simões e Silva AC, Santos RAS designed the research; Vilas-Boas WW, Cunha Ribeiro R, Vieira RLP, Almeida J, Nadu AP performed the research; Vilas-Boas WW, Ribeiro-Oliveira Jr A, Simões e Silva AC analyzed the data; Vilas-Boas WW, Ribeiro-Oliveira Jr A, Simões e Silva AC, Santos RAS wrote the paper.
Supported by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais), CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) and PRONEX (Grupos de Excelência)
Correspondence to: Robson Augusto Souza Santos, MD, PhD, Departamento de Fisiologia e Biofísica, ICB-UFMG, Av. Antonio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil. marrob@dedalus.lcc.ufmg.br
Telephone: +55-31-3499-2956 Fax: +55-31-3499-2924
Received: September 26, 2008
Revised: November 11, 2008
Accepted: November 18, 2008
Published online: November 28, 2008
Abstract

AIM: To evaluate the effect of β-blockade on angiotensins in the splanchnic and peripheral circulation of cirrhotic patients and also to compare hemodynamic parameters during liver transplantation according to propranolol pre-treatment or not.

METHODS: Patients were allocated into two groups: outpatients with advanced liver disease(LD) and during liver transplantation(LT). Both groups were subdivided according to treatment with propranolol or not. Plasma was collected through peripheral venipuncture to determine plasma renin activity(PRA), Angiotensin(Ang) I, Ang II, and Ang-(1-7) levels by radioimmunoassay in LD group. During liver transplantation, hemodynamic parameters were determined and blood samples were obtained from the portal vein to measure renin angiotensin system(RAS) components.

RESULTS: PRA, Ang I, Ang II and Ang-(1-7) were significantly lower in the portal vein and periphery in all subgroups treated with propranolol as compared to non-treated. The relationships between Ang-(1-7) and Ang I levels and between Ang II and Ang I were significantly increased in LD group receiving propranolol. The ratio between Ang-(1-7) and Ang II remained unchanged in splanchnic and peripheral circulation in patients under β-blockade, whereas the relationship between Ang II and Ang I was significantly increased in splanchnic circulation of LT patients treated with propranolol. During liver transplantation, cardiac output and index as well systemic vascular resistance and index were reduced in propranolol-treated subgroup.

CONCLUSION: In LD group, propranolol treatment reduced RAS mediators, but did not change the ratio between Ang-(1-7) and Ang II in splanchnic and peripheral circulation. Furthermore, the modification of hemodynamic parameters in propranolol treated patients was not associated with changes in the angiotensin ratio.

Keywords: β-blockade; Cirrhosis; Renin angiotensin system; Angiotensin-(1-7)