European Journal of Gastroenterology & Hepatology | 2019
Dose-dependent effect of propranolol on the hemodynamic response in cirrhotic patients with gastroesophageal varices
Abstract
Objective Propranolol is always titrated to the maximum tolerated dose to prevent gastroesophageal variceal bleeding. However, some patients do not achieve a hemodynamic response and experience more intolerance and discontinuation. This study evaluated the dose-dependent effect of propranolol on hemodynamic response and tolerance in cirrhotic patients. Patients and methods This retrospective study included 95 consecutive patients recruited from our prospective database. After hepatic venous pressure gradient measurement, patients received propranolol 10\u2009mg, twice daily increased 10\u2009mg daily until to 80 or 120\u2009mg/day. Secondary hepatic venous pressure gradient was also measured. For nonresponders at 80\u2009mg/day, propranolol was titrated to 120\u2009mg/day. Results For 58 patients, propranolol was titrated to 80\u2009mg/day, whereas for 37 patients, it was titrated to 120\u2009mg/day. Hemodynamic response was similar in both groups (50 vs. 54.1%, P=0.700). Eighteen of the 29 nonresponders at propranolol 80\u2009mg/day received a dose of 120\u2009mg/day. Two patients achieved a hemodynamic response, but two could not tolerate the dose. Nine (15.5%) patients achieved the target dose of propranolol at 80\u2009mg/day, whereas 16 (43.2%) patients at 120\u2009mg/day achieved this (P=0.003). The difference in patients achieving the target dose between responders and nonresponders was not significant (14 vs. 14, P=0.642). Reduction or discontinuation was required by two (6.9%) patients using 80\u2009mg/day propranolol and six (30%) patients using 120\u2009mg/day propranolol (P=0.032). Conclusion There is no dose-dependent effect of 80–120\u2009mg/day of propranolol on the hemodynamic response in cirrhotic patients with gastroesophageal varices. This indicates that low-dose propranolol below the target dose might lead to a considerable hemodynamic response and is much safer and well tolerated.