Skip to main content
SpringerLink
Log in

Hypertension and liver disease

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Arterial hypertension is a common disorder with a frequency of 10% to 15% in subjects in the 40- to 60-year age group. Yet most reports find the prevalence of arterial hypertension in patients with chronic liver disease (cirrhosis) much lower. In this review, we consider the alterations in systemic hemodynamics in cirrhosis. The most characteristic findings in cirrhotic patients are vasodilatation with low systemic vascular resistance, increased cardiac output, high arterial compliance, secondary activation of counterregulatory systems (sympathetic nervous system, renin-angiotensin-aldosterone system, neuropituitary release of vasopressin), and resistance to vasopressors. The vasodilatory state is mediated through nitric oxide, calcitonin gene-related peptide, adrenomedullin, and other vasodilators, and is most pronounced in the splanchnic area. This constitutes an effective (although relative) counterbalance to increased arterial blood pressure. Subjects with established arterial hypertension (essential, secondary) may become normotensive during the development of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homeostatic regulation in cirrhotic patients with manifest arterial hypertension. This is a topic for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Cohen L, Guillevin L, Meyrier A, et al.: Malignant arterial hypertension in periarteritis nodosa. Incidence, clinicobiologic parameters and prognosis based on series of 165 cases. Arch Mal Coeur Vaiss 1986, 79:773–778.

    PubMed  CAS  Google Scholar 

  2. Klatsky A, Friedman GD, Siegelaub AB, Gerard MJ: Alcohol consumption and blood pressure. Kaiser-Permanente Multiphasic Health Examination Data. N Engl J Med 1977, 296:1194–1200.

    Article  PubMed  CAS  Google Scholar 

  3. Ascherio A, Rimm EB, Giovannucci EL, et al.: A prospective study of nutritional factors and hypertension among US men. Circulation 1992, 86:1475–1484.

    PubMed  CAS  Google Scholar 

  4. Potter JF, Beevers DG: Pressor effect of alcohol in hypertension. Lancet 1984, i:119–120.

    Article  Google Scholar 

  5. Arroyo V, Gines P, Jimenez W, Rodes J: Ascites, renal failure, and electrolyte disorders in cirrhosis. Pathogenesis, diagnosis, and treatment. In Oxford Textbook of Clinical Hepatology. Edited by McIntyre N, Benhamou JP, Bircher J, et al. Oxford: Oxford University Press; 1991:427–470. Comprehensive survey of arterial blood pressure, renal function, vasodilatation, and volume distribution in cirrhotic patients during progression.

    Google Scholar 

  6. Schrier RW, Arroyo V, Bernardi M, et al.: Peripheral artery vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988, 5:1151–1157. First study to analyze in depth the background of the hemodynamic changes in cirrhosis with emphasis on vasodilatation as an important primary element.

    Article  Google Scholar 

  7. Groszmann RJ: Vasodilatation and hyperdynamic circulatory state in chronic liver disease. In Portal Hypertension. Pathophysiology and Treatment. Edited by Bosch J, Groszmann RJ. Oxford: Blackwell; 1994:17–26. Classic work on hemodynamic changes in chronic liver disease.

    Google Scholar 

  8. Henriksen JH, Bendtsen F, Sørensen TIA, et al.: Reduced central blood volume in cirrhosis. Gastroenterology 1989, 97:1506–1513.

    PubMed  CAS  Google Scholar 

  9. Henriksen JH, Fuglsang S, Bendtsen F, et al.: Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index. Am J Physiol Gastrointest Liver Physiol 2001, 280:G584-G594. Extensive analysis of arterial mechanical properties in patients with cirrhosis and arterial hypertension. Analysis of arterial compliance measurement in patients with arterial hypertension and liver disease.

    PubMed  CAS  Google Scholar 

  10. Møller S, Henriksen JH, Bendtsen F: Central and noncentral blood volumes in cirrhosis: relationship to anthropometrics and gender. Am J Physiol Gastrointest Liver Physiol 2003, 284:G970-G979.

    PubMed  Google Scholar 

  11. Krousel-Wood MA, Muntner P, He J, Whelton PK: Primary prevention of essential hypertension. Med Clin North Am 2004, 88:223–238.

    Article  PubMed  Google Scholar 

  12. Andersen UO, Henriksen JH, Jensen G: Sources of measurement variation in blood pressure in large-scale epidemiological surveys with follow-up. The Copenhagen City Heart Study Group. Blood Press 2002, 11:357–365.

    Article  PubMed  Google Scholar 

  13. Ekataksin W, Kaneda K: Liver microvascular architecture: an insight into the pathophysiology of portal hypertension. Semin Liver Dis 1999, 19:359–382.

    PubMed  CAS  Google Scholar 

  14. Wiest R, Groszmann RJ: The paradox of nitric oxide in cirrhosis and portal hypertension: too much, not enough. Hepatology 2002, 35:478–491. Describes the abnormal distribution of nitric oxide synthase with increased activity in the systemic circulation and reduced activity in hepatic microvessels.

    Article  PubMed  CAS  Google Scholar 

  15. Martin PY, Gines P, Schrier RW: Mechanisms of disease: nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis. N Engl J Med 1998, 339:533–541.

    Article  PubMed  CAS  Google Scholar 

  16. Ring-Larsen H, Henriksen JH: Pathogenesis of ascites formation and hepatorenal syndrome: humoral and hemodynamic factors. Semin Liver Dis 1986, 6:341–352.

    PubMed  CAS  Google Scholar 

  17. Møller S, Bendtsen F, Henriksen JH: Vasoactive substances in the circulatory dysfunction of cirrhosis. Scand J Clin Lab Invest 2001, 61:421–430.

    Article  PubMed  Google Scholar 

  18. Møller S, Bendtsen F, Henriksen JH: Splanchnic and systemic hemodynamic derangement in decompensated cirrhosis. Can J Gastroenterol 2001, 15:94–106.

    PubMed  Google Scholar 

  19. Jimenez W, Arroyo: Origins of cardiac dysfunction in cirrhosis. Gut 2003, 52:1392–1394. Deepened analysis of cardiac dysfunction in cirrhosis as a possible consequence of hyperdynamic circulation and specific damage by the cirrhotic liver.

    Article  PubMed  CAS  Google Scholar 

  20. Liu H, Song D, Lee SS: Cirrhotic cardiomyopathy. Gastroenterol Clin Biol 2002, 26:842–847.

    PubMed  Google Scholar 

  21. Gentilini P, Romanelli RG, Laffi G, et al.: Cardiovascular and renal function in normotensive and hypertensive patients with compensated cirrhosis: effects of posture. J Hepatol 1999, 30:632–638. Extensive human pathophysiologic study of normotensive and hypertensive patients with cirrhosis. Compensated cirrhotic patients with arterial hypertension have no evidence of hyperdynamic circulation. Like their normotensive counterparts, hypertensive cirrhotic patients have impaired cardiovascular response to postural changes, but a lesser degree of renal dysfunction when standing. Plasma renin activity is similar in normotensive and hypertensive cirrhotic patients.

    Article  PubMed  CAS  Google Scholar 

  22. Lopez C, Jimenez W, Arroyo V, et al.: Temporal relationship between the decrease in arterial pressure and sodium retention in conscious spontaneously hypertensive rats with carbon tetrachloride-induced cirrhosis. Hepatology 1991, 13:585–589. Temporal relationship of arterial blood pressure changes during decompensation in experimental cirrhosis.

    PubMed  CAS  Google Scholar 

  23. Loyke HF: Reduction of hypertension after liver disease. Arch Intern Med 1962, 110:45–49. Several longitudinal patient cases documenting reduction of arterial blood pressure in hypertensive patients after onset of liver disease, even in patients with renovascular hypertension.

    PubMed  CAS  Google Scholar 

  24. Spatt SD, Rosenblatt P: The incidence of hypertension in portal cirrhosis: a study of 80 necropsied cases of portal cirrhosis. Ann Int Med 1949, 31:479–483. A clear documentation that the incidence of hypertension in patients with portal cirrhosis is significantly lower than in the general population as evaluated by blood pressure measurements and measurement of heart weight.

    PubMed  CAS  Google Scholar 

  25. Loyke HF, Cutarelli R: An evaluation of hypertension and liver disease in an alcoholic service. Am J Med Sci 1960, 240:346–351. This study brings evidence of a definite, but lower incidence of arterial hypertension in patients with liver disease.

    PubMed  CAS  Google Scholar 

  26. Schrier RW: Renin-angiotensin in preascitic cirrhosis: evidence for primary peripheral arterial vasodilution. Gastroenterology 1998, 115:489–91.

    Article  PubMed  CAS  Google Scholar 

  27. Møller S, Wiinberg N, Henriksen JH: Noninvasive 24-hour ambulatory arterial blood pressure monitoring in cirrhosis. Hepatology 1995, 22:88–95. Extensive study of 24-hour blood pressure measurement in patients with cirrhosis. These patients are hypotensive during the daytime and have normal blood pressure at night. Heart rate-blood pressure relations indicate abnormal baroreceptor function in patients with cirrhosis.

    PubMed  Google Scholar 

  28. Loyke HF: The relationship of cirrhosis of the liver to hypertension: a study of 504 cases of cirrhosis of the liver. Am J Med Sci 1955, 230:627–632. This study shows that hypertension does not usually occur in the presence of cirrhosis and that established hypertension can be reversed to normal blood pressure with the onset of cirrhosis.

    PubMed  CAS  Google Scholar 

  29. Veglio F, Pinna G, Melchio R, et al.: Hormonal aspects of the relation of liver cirrhosis to essential hypertension. Clin Exp Hypertens 1992, 14:889–903. Arterial hypertensive cirrhotic patients show decreased renin-angiotensin activity, reduced systemic vasodilatation, and increased peripheral pressor effects of vasoactive hormones. The study points to possibility of an increased effective blood volume.

    CAS  Google Scholar 

  30. Raaschou F: Blood pressure and heart weight in chronic hepatitis: Does the liver play a role in the development of essential hypertension? Nord Med 1949, 46:1791–1795. The hypothesis that normal or only slightly impaired liver function is a prerequisite for arterial hypertension in humans is presented. Severely impaired liver function can prevent the development of arterial hypertension.

    Google Scholar 

  31. Henriksen JH, Møller S, Schifter S, et al.: High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems. Gut 2001, 49:112–118.

    Article  PubMed  CAS  Google Scholar 

  32. Brinch K, Møller S, Bendtsen F, et al.: Plasma volume expansion by albumin in cirrhosis: relation to blood volume distribution, arterial compliance and severity of disease. J Hepatol 2003, 39:24–31.

    Article  PubMed  CAS  Google Scholar 

  33. Møller S, Gülberg V, Becker U, et al.: Elevated arterial compliance in patients with cirrhosis is not related to arterial endothelin-1. Scand J Gastroenterol 2002, 37:1064–1069.

    Article  PubMed  Google Scholar 

  34. Henriksen JH, Gülberg V, Gerbes AL, et al.: Increased arterial compliance in cirrhosis is related to decreased arterial C-type natriuretic peptide, but not to atrial natriuretic peptide. Scand J Gastroenterol 2003, 38:559–564.

    Article  PubMed  CAS  Google Scholar 

  35. Møller S, Henriksen JH: Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart 2002, 87:9–15. Comprehensive review of cardiac dysfunction in patients with cirrhosis.

    Article  PubMed  Google Scholar 

  36. Møller S, Hansen EF, Becker U, et al.: Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients. Liver 2000, 20:51–59.

    Article  PubMed  Google Scholar 

  37. D’Amico G: The role of vasoactive drugs in the treatment of oesophageal varices. Expert Opin Pharmacother 2004, 5:349–360.

    PubMed  CAS  Google Scholar 

  38. Kiszka-Kanowitz M, Henriksen JH, Møller S, Bendtsen F: Blood volume distribution in patients with cirrhosis: aspects of the dual-head gamma-camera technique. J Hepatol 2001, 35:605–612.

    Article  PubMed  CAS  Google Scholar 

  39. Hadengue A, Moreau R, Gaudin C, et al.: Total effective vascular compliance in patients with cirrhosis: a study of the response to acute blood volume expansion. Hepatology 1992, 15:809–815.

    Article  PubMed  CAS  Google Scholar 

  40. Andreu V, Perello A, Moitinho E, et al.: Total effective vascular compliance in patients with cirrhosis: effects of propranolol. J Hepatol 2002, 36:356–361.

    Article  PubMed  CAS  Google Scholar 

  41. Møller S, Bendtsen F, Henriksen JH: Effect of volume expansion on systemic hemodynamics and central and arterial blood volume in cirrhosis. Gastroenterology 1995, 109:1917–1925. Classic work on abnormal distribution of volume expansion in cirrhosis.

    Article  PubMed  Google Scholar 

  42. Henriksen JH, Fuglsang S, Bendtsen F, et al.: Dyssynchronous electrical and mechanical systole in patients with cirrhosis. J Hepatol 2002, 36:513–520.

    Article  PubMed  Google Scholar 

  43. Henriksen JH, Gøtze JP, Fuglsang S, et al.: Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease. Gut 2003, 52:1511–1517.

    Article  PubMed  CAS  Google Scholar 

  44. Gines P, Guevara M, Arroyo V, Rodes J: Hepatorenal syndrome. Lancet 2003, 362:1819–1827.

    Article  PubMed  CAS  Google Scholar 

  45. Moore K: Endothelin and vascular function in liver disease. Gut 2004, 53:159–161.

    Article  PubMed  CAS  Google Scholar 

  46. Møller S, Gülberg V, Henriksen JH, et al.: Endothelin-1 and endothelin-3 in cirrhosis: relations to systemic and splanchnic haemodynamics. J Hepatol 1995, 23:135–144.

    Article  PubMed  Google Scholar 

  47. Mohammed R, Forsey PR, Davies MK, Neuberger JM: Effect of liver transplantation on QT interval prolongation and autonomic dysfunction in end-stage liver disease. Hepatology 1996, 23:1128–1134.

    Article  Google Scholar 

  48. Vallance P, Moncada S: Hyperdynamic circulation in cirrhosis: a role for nitric oxide. Lancet 1991, 337:776–778.

    Article  PubMed  CAS  Google Scholar 

  49. Henriksen JH, Ring-Larsen H: Renal effects of drugs used in the treatment of portal hypertension. Hepatology 1993, 18:688–695.

    Article  PubMed  CAS  Google Scholar 

  50. Schwartz DT: The relation of cirrhosis of the liver to renal hypertension: a review of 639 autopsied cases. Ann Intern Med 1967, 66:862–869. Documentation of a 50% return of increased arterial blood pressure to normal levels with the development of cirrhosis in hypertensive patients of renal etiology.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Physiology, 239, Hvidovre University Hospital, DK-2650, Hvidovre, Denmark

    Jens H. Henriksen MD & Søren Møller MD

Authors
  1. Jens H. Henriksen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Søren Møller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Henriksen, J.H., Møller, S. Hypertension and liver disease. Current Science Inc 6, 453–461 (2004). https://doi.org/10.1007/s11906-004-0041-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-004-0041-5

Keywords

Search

Navigation