Hemodynamic effect of spironolactone in liver cirrhosis and propranolol-resistant portal hypertension

Indian J Gastroenterol. Jul-Aug 2002;21(4):145-8.


Objective: In a proportion of patients with liver cirrhosis, portal pressure does not decrease adequately with propranolol. These patients may benefit from another drug that may reduce portal pressure. We evaluated the role of spironolactone, alone or with propranolol, in such patients.

Methods: Patients with cirrhosis, with or without ascites, with esophageal varices and with hepatic venous pressure gradient exceeding 12 mmHg, which did not show a 20% reduction after an 80-mg oral dose of propranolol, were studied. They were allocated to receive spironolactone 100 mg orally once daily either alone (group 1, n=10) or with propranolol 40 mg orally twice daily (group 2, n=10), for 7 days, after which the hemodynamic study was repeated.

Results: Hepatic venous pressure gradient decreased in those receiving spironolactone and propranolol (p=0.007); 5 patients in group 1 and 7 in group 2 showed a reduction in hepatic venous pressure gradient by more than 20%. However, the reduction produced by spironolactone alone (20.5 [31.3]%) was not significantly different from that produced by combination therapy (30.3 [25.9]%; p=0.46).

Conclusion: Spironolactone in combination with propranolol achieves adequate reduction (> or = 20%) in hepatic venous pressure gradient in propranolol-resistant portal hypertension in patients with liver cirrhosis. Spironolactone alone was also effective in some patients.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Adult
  • Diuretics / therapeutic use*
  • Drug Therapy, Combination
  • Esophageal and Gastric Varices / prevention & control
  • Female
  • Gastrointestinal Hemorrhage / prevention & control
  • Humans
  • Hypertension, Portal / drug therapy*
  • Hypertension, Portal / physiopathology
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / physiopathology
  • Male
  • Portal System / drug effects*
  • Propranolol / therapeutic use*
  • Spironolactone / therapeutic use*


  • Adrenergic beta-Antagonists
  • Diuretics
  • Spironolactone
  • Propranolol