Clinical

Sildenafil does not improve portal pressure in compensated cirrhosis

Last Updated: 2010-03-11 10:00:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Sildenafil reduces arterial pressure but not portal pressure in patients with compensated cirrhosis, according to a report published online February 8th in Clinical Gastroenterology and Hepatology.

Phosphodiesterase-5 inhibitors such as sildenafil increase vascular smooth muscle relaxation. Studies of these drugs in patients with portal hypertension have shown conflicting results, possibly because most trials included patients with decompensated cirrhosis, the researchers say.

For their recent open-label pilot study, Dr. Puneeta Tandon and colleagues at Yale University School of Medicine, New Haven, Connecticut, recruited only patients with compensated cirrhosis (i.e., no ascites, bleeding varices, jaundice, or encephalopathy).

Twelve patients (median age, 55 years) with baseline hepatic venous pressure gradient (HVPG) >5 mm Hg received 25 mg of oral sildenafil. The researchers re-measured HVPG at 30 and 60 minutes, and they gave patients a second dose of 25 mg if mean arterial pressure had not fallen by more than 15% from baseline and the patient was asymptomatic. The investigators made their final HVPG measurements at 90 minutes.

Altogether, 11 patients had 30-minute HVPG measurements, 12 had 60-minute measurements, and 9 had 90-minute measurements.

The median baseline mean arterial pressure was 93 mm Hg, and the median baseline HVPG was 10.4 mm Hg. Sildenafil produced significant median decreases in mean arterial pressure of 7, 6.5, and 8 mm Hg at 30, 60, and 90 minutes, respectively, with no significant change in heart rate - but it had no effect on HVPG or on hepatic venous wedge pressure.

"The search should continue for specific intrahepatic vasodilators," the authors conclude.

Clin Gastroenterol Hepatol 2010.