Resposta hemodinâmica durante o estresse mental em pacientes com cirrose hepática: influência do β-bloqueador

Abstract

Introduction: Patients with hepatic cirrhosis may show hemodynamic alterations at rest, marked by low values of blood pressure. Besides those alterations at rest, these patients also may show alterations in situations that demand a greater exigence from the cardiovascular system. Among those situations, physical exercise and mental stress are prominent. In regard to physical exercise, we noted that patients with hepatic cirrhosis show a low blood pressure response during isometric physical exercise. Thus, these patients are also likely to show hemodynamic alterations due to mental stress. Objective: Evaluate hemodynamic parameters during mental stress in patients with hepatic cirrhosis. Methods: Nineteen patients with hepatic cirrhosis were evaluated (13 Child A, 5 Child B and 1 Child C) distributed in the following groups: Patients without use of beta-blocker (Group Without β Adrenergic Receptor, n=11) and patients with use of β Adrenergic Receptor (Group with β, n=8). In addition, a group integrated by 16 people with no hepatic cirrhosis (Group Control), paired in age and gender, was evaluated. The mental stress was induced by Stroop Color Word Conflict Test. The blood pressure variables were measured beat by beat (Finometer®), the cardiac frequency by electrocardiogram (Biopac) and the blood flow of the forearm by plethysmograph of venous occlusion (Hokanson®) during 3 basal minutes followed by 3 minutes of mental stress. The peripheral vascular conductance was calculated dividing the blood flow of the forearm by the mean blood pressure and reported in unities. A T test was carried out on the at-rest variables and Anova of two factors for the response (Δ) to mental stress, considered significant p≤0,05. Results: At rest, there were not differences observed between the groups without β and Control for systolic blood pressure (135±18 vs. 132±13 mmHg p=0,58), diastolic blood pressure (74 ±7 vs. 73±8 mmHg p=0,82), cardiac frequency (64±8 vs. 69±10bpm p=0,16) and peripheral vascular conductance (2,98±1,08 vs. 2,83±1,05 unities p=0,72), respectively. During mental stress, despite the significant increase in regard to the basal time effect p<0,01 of the two groups Without β and Control in the systolic blood pressure (Δ1ºmin: 3±1 vs. 9±1; Δ2ºmin: 5±3 vs. 12±2; Δ3ºmin: 6±3 vs. 11±2 mmHg, respectively interaction effect p=0,09) and in the diastolic blood pressure (Δ1º min: 2±1 vs. 5±1; Δ2ºmin: 3±1 vs. 7±1; Δ3ºmin: 3±1 vs. 6±1 mmHg, respectively interaction effect p=0,06), the group Without β showed a significantly depressed response compared with the Group Control group effect p=0,04 e p=0,03 respectively. The cardiac frequency significantly increased in regard to the basal time effect p=<0,01 and in the same way among the groups Without β and Group Control (Δ1ºmin: 6±2 vs. 12±2; Δ2ºmin: 6±2 vs. 10±2; Δ3ºmin: 6±2 vs. 9±2 bpm, respectively interaction effect p=0,09). On the other hand, despite the significant increase in regard to the basal time effect p=<0,01 observed in both groups, the response of the peripheral vascular conductance was crucially greater in the group Without β compared with the Group Control (Δ1ºmin: 1,08±0,33 vs. 1,34±0,33; Δ2ºmin: 1,28±0,33 vs. 0,79±0,27; Δ3ºmin: 1,62±0,34 vs. 0,50±0,28 unities, respectively interaction effect p=0,01). In regard to the group With β, at rest, the cardiac frequency was significantly lower compared with the Group Control (58±9 vs. 69±10bpm p=0,01). The groups With β and Control were similar at rest in terms of systolic blood pressure values (132±16 vs. 132±13mmHg p=0,93), diastolic blood pressure (69±6 vs. 73±8mmHg p=0,13) and peripheral vascular conductance (2,38±0,66 vs. 2,83±1,05 unities p=0,21). During mental stress the groups With β and Control showed a significant increase in regard to basal time effect p<0,01 and, likewise, for systolic blood pressure (Δ1ºmin: 6±2 vs. 9±1; Δ2ºmin: 11±3 vs. 12±2; Δ3ºmin: 10±3 vs. 11±2 mmHg interaction effect p=0,66), diastolic blood pressure (Δ1ºmin: 4±1 vs. 5±1; Δ2ºmin: 6±2 vs. 7±1; Δ3ºmin: 5±2 vs. 6±1 mmHg interaction effect p=0,93), cardiac frequency (Δ1ºmin: 9±3 vs. 12±2; Δ2ºmin: 9±3 vs. 10±2; Δ3ºmin: 8±3 vs. 9±2 bpm interaction effect p=0,55), and peripheral vascular conductance (Δ1ºmin: 1,73±0,48 vs. 1,34±0,34; Δ2ºmin: 1,04±0,39 vs. 0,79±0,27; Δ3ºmin: 0,66±0,26 vs. 0,50±0,19 unities interaction effect p=0,83). Conclusion: Patients with hepatic cirrhosis without use of beta-blocker show a depressed response in the systolic and diastolic, as well as in the exacerbated vasodilation during acute mental stress when compared with individuals without hepatic cirrhosis. Besides that, those inadequate responses are suggested to be normalized with the use of beta-blocker.