Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: A randomized controlled trial

Abstract

Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.

Hemodynamic effects of renin-angiotensin-aldosterone inhibitor and β-blocker combination therapy vs. β-blocker monotherapy for portal hypertension in cirrhosis: A meta-analysis

“…A total of three studies comparing the RAAS inhibitor and β-blocker combination therapy with β-blocker monotherapy were included. In one study (8), the treated group was administered propranolol 40 mg bid and spironolactone 100 mg qd, while the control group was administered propranolol at a dose of 40 mg bid and a placebo tablet. Moreover, the dose of propranolol was gradually increased until there was a decrease in pulse rate of >20% from the baseline, or a pulse rate of 60 beats per minute was achieved.…”

“…Theoretically, as RAAS inhibitors and β-blockers function via different mechanisms to decrease the pressure of portal veins, it is possible that the RAAS inhibitor and β-blocker combination therapy may lead to a more significant reduction in portal venous pressure. Several studies (8)(9)(10) have previously compared the RAAS inhibitor and β-blocker combination therapy vs. β-blocker monotherapy. However, the results remain inconsistent.…”

Renin–angiotensin–aldosterone inhibitors in the reduction of portal pressure: A systematic review and meta-analysis

“…All of the AA trials utilized spironolactone [10,40,[46][47][48]50,51]. Details regarding treatment and control medication doses and duration of administration are found in Table 3.…”

“…Three trials evaluated ACEi's [39,41,42], nine trials evaluated ARB's [6,[12][13][14][43][44][45]49] and seven trials evaluated AA's [10,40,[46][47][48]50,51].…”

“…criteria but since one trial expressed HVPG results as divided by moderate and severe portal hypertension, this trial was counted twice [12], bringing the final total of included studies to nineteen [6,10,[12][13][14][39][40][41][42][43][44][45][46][47][48][49][50][51]. Three trials evaluated ACEi's [39,41,42], nine trials evaluated ARB's [6,[12][13][14][43][44][45]49] and seven trials evaluated AA's [10,40,[46][47][48]50,51].…”