Source: Hepatology  |  Posted 9 years ago

The combined use of nadolol and spironolactone in patients with liver cirrhosis reduces the incidence of the two portal-hypertensive complications, bleeding and ascites, together.

Adding spironolactone to nadolol, however, does not increase the efficacy of nadolol alone in preventing the first variceal bleeding, report gastroenterological specialists in Buenos Aires, Argentina.

They pointed out that treatment with beta-blockers did not lower portal pressure in nearly 40% of cirrhotic patients. Also, recent studies had suggested that spironolactone reduced pressure and flow in the portal and variceal systems.

The specialists, therefore, looked into whether nadolol plus spironolactone was more effective than nadolol alone in preventing the first variceal bleeding.

In a multi-centre, double-blind, trial, the specialists randomised 100 patients with medium and large varices who had never bled and were without ascites to receive nadolol plus placebo or nadolol plus spironolactone 100 mg. daily.

Hepatic venous pressure gradient and the activity of the renin-aldosterone system were measured in 24 of the patients.

At a mean follow-up of 22