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Octreotide Enhances Portal Pressure Reduction Induced by Propranolol in Cirrhosis: A Randomized, Controlled Trial

BACKGROUND:In vitro, octreotide potentiates vasoconstriction in isolated, preconstricted, mesenteric arterial vessels. In cirrhotic patients, portal pressure (HVPG) reduction induced by propranolol is partly due to splanchnic vasoconstriction.AIM:To evaluate HVPG effects of octreotide administration in cirrhotic patients receiving long-term propranolol.PATIENTS AND METHODS:A randomized, controlled trial. First study: a total of 28 patients were studied at baseline and 30 and 60 minutes after octreotide (200 μg) (N = 14) or placebo (N = 14) and then treated with propranolol for approximately 30 days (106 ± 5 mg/day). Second study: after baseline evaluation patients received octreotide or placebo as they were assigned to in the first study and measurements repeated 30 and 60 minutes later.RESULTS:In the first study baseline HVPG was 18.7 ± 0.9 mmHg and decreased to 17.1 ± 1.1 mmHg and 17.1 ± 1.0 mmHg (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Eight patients decreased their HVPG after octreotide. In the second study baseline HVPG was 15.6 ± 1.3 mmHg (P < 0.01 vs baseline HVPG in first study) and decreased to 14.1 ± 1.2 mmHg and 14.1 ± 1.3 mmHg (25.7 ± 5% lower than baseline HVPG in the first study, P < 0.01) (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Nine patients (2 responders/7 nonresponders to propranolol) decreased their HVPG after octreotide. Octreotide effects may be mediated by potentiation and additive mechanisms.CONCLUSIONS:Octreotide enhances HVPG reduction induced by propranolol in cirrhotic patients.