Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

“…Two meta-analyses (13,42) confirmed a significant reduction of rebleeding from 68% to 48% at 2 years of follow-up with a reduction in mortality of 5% (42) . In addition, three other RCT with prolonged follow-up periods have demonstrated that patients with a satisfactory response to NSBB, determined by a fall of HVPG <12 mm Hg, have lower risk of bleeding recurrence and mortality as well as other complications of cirrhosis such as ascitis, SBP, hepatic encephalopathy and renal failure (2,148,154) . Therefore, NSBB remains the first-line drug for secondary prophylaxis of variceal bleeding (13,42) .…”

Wedged hepatic vein pressure (WHVP): Ready for prime time

“…[3][4][5][6] Hemodynamic responders appear less likely to develop other complications of cirrhosis as well. 7 Also, a high HVPG (Ͼ20 mm Hg) at the time of presentation of variceal bleeding is associated with a poor outcome as compared to patients with lower pressures. 8 Despite the consistency of the reported series on the importance of measuring the HVPG in determining risk of variceal bleeding or rebleeding, numerous problems with the published studies exist, especially the absence of prospective data demonstrating that using the hemodynamic response to alter therapy is beneficial to the patients.…”

Clinical trial: a randomized controlled study on prevention of variceal rebleeding comparing nadolol + ligation vs. hepatic venous pressure gradient‐guided pharmacological therapy

“…21,22 However, evidence suggests that haemodynamic response may be a relevant therapeutic target, as it is linked with improved efficacy and survival. 6,7 Although there has been some controversy regarding the prognostic value of a reduction in HVPG >20% from baseline, this has mainly been based on a single study 23 the methodology of which is controversial. 24 Furthermore, a systematic review of all available trials assessing HVPG monitoring clearly confirmed the value of this threshold.…”