Abstract
BackgroundThere is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements.MethodsAmbulatory patients with cirrhosis underwent office blood pressure and heart rate measurements, 24-hour ambulatory blood pressure monitoring and blood laboratory tests.ResultsFifty-one patients (32 men, mean age 57.4 ± 11.3 years) completed the study. Twenty six patients had compensated liver cirrhosis (group A) and 25 patients had more advanced liver disease (group B). Group A and B patients differed significantly both in ambulatory asleep diastolic blood pressure (p < 0.05) and office diastolic blood pressure (p < 0.01), which were lower in more advanced liver disease. Office blood pressure and heart rate correlations were similar to or even stronger than ambulatory ones. Ambulatory blood pressure and heart rate awake-asleep variation (dipping) showed a relatively flat pattern as markers of liver dysfunction were deteriorating. The strongest correlations were found with both ambulatory and office heart rate, which increased as indicators of severity of liver disease were worsening.ConclusionsHeart rate seems to be a more reliable marker of ongoing liver dysfunction than blood pressure. Evaluation of blood pressure and heart rate with 24-hour ambulatory measurement does not seem to offer more information than conventional office measurements.
Highlights
There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease
Hepatic cirrhosis is accompanied by alterations of systemic circulation, such as reduced peripheral vascular resistance, low or low-normal blood pressure (BP) and increased heart rate (HR), stroke volume and cardiac output at rest, a situation which is called “hyperdynamic circulation”
This study showed that HR, measured either with ambulatory blood pressure (ABP) monitoring or conventional office measurement, seems to be a more reliable marker of ongoing liver dysfunction than BP
Summary
There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements. Hepatic cirrhosis is accompanied by alterations of systemic circulation, such as reduced peripheral vascular resistance, low or low-normal blood pressure (BP) and increased heart rate (HR), stroke volume and cardiac output at rest, a situation which is called “hyperdynamic circulation”. These alterations deteriorate further with the aggravation of hepatocellular failure [1,2,3,4,5]. As long as office BP and HR are related to the severity of liver damage, a detailed assessment of the BP profile, as provided by 24-hour ABP measurement, would be proved a reliable index of liver dysfunction
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