Effects of low-sodium diet and spironolactone on portal pressure in patients with compensated cirrhosis

Abstract

The aim of this study was to investigate the hemodynamic effects of spironolactone associated with a low‐sodium diet (n=14) or a low‐sodium diet alone (n=9) in patients with compensated cirrhosis and portal hypertension. Spironolactone significantly reduced the plasma volume. This effect was associated with a significant reduction in the hepatic venous pressure gradient, from 17.6 ± 3.6 mm Hg to 15.3 ± 3.5 mm Hg (−13% ± 13%; p<0.01). Azygos blood flow (−20% ± 20%), cardiac output (−16.2% ± 10.5%) and mean arterial pressure (−9% ± 9%) also decreased significantly. However, there were no significant changes in hepatic blood flow. Patients receiving low‐sodium diet alone experienced a mild but significant reduction in hepatic venous pressure gradient (−6.3% ± 6%) and in mean arterial pressure (−4% ± 5%). There were no significant changes in cardiac output and in hepatic or azygos blood flows. This study indicates that low‐sodium diet plus administration of spironolactone reduces portal pressure and azygos blood flow in patients with compensated cirrhosis. Low‐sodium diet alone only produces mild effects that are likely to be clinically irrelevant. (HEPATOLOGY 1994;19:1095–1099.)