Pharmacological Reduction of Portal Pressure and Long-Term Risk of First Variceal Bleeding in Patients with Cirrhosis

Abstract

The hemodynamic response in cirrhotic patients is associated with a sustained reduction in the risk of first variceal bleeding over a long-term follow-up. Reduction of HVPG also correlate with a reduced risk of SBP or bacteremia.

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

“…Selective ␤-blockers (atenolol, metoprolol) are less effective and are suboptimal for primary prophylaxis of variceal hemorrhage. A decrease in HVPG Ͻ12 mmHg essentially eliminates the risk of hemorrhage and improves survival, 17 while reductions Ͼ20% from baseline 56 or even Ͼ10% from baseline 57 significantly decrease the risk of first variceal hemorrhage.…”

Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: A clinical-hemodynamic correlation study

“…The original studies 4,5,25 included 309 patients. Of these, 154 patients had simultaneous HVPG and RAP measurements (60 from Abraldes et al, 4 56 from Turnes et al, 5 and 38 from La Mura et al 25 ) before and during continued therapy with nonselective beta-blockers and were included in the final analysis. Clinical, endoscopic, and hemodynamic characteristics are reported in Tables 1 and 2.…”

“…We reviewed the data of cirrhotic patients with esophageal varices enrolled in three previous longitudinal studies 4,5,25 to assess the prognostic value of HVPG changes induced by drug therapy for portal hypertension. Inclusion criteria for the present study were: diagnosis of cirrhosis (based on liver biopsy and/or unequivocal clinical data and compatible findings on imaging techniques); presence of esophageal varices; baseline HVPG values >12 mm Hg; subsequent chronic treatment with nonselective betablockers (propranolol or nadolol) after baseline hemodynamic evaluation; second HVPG measurement after 1-6 months of continued pharmacological therapy; and measurement of RAP in both hemodynamic studies.…”

“…[4][5][6][7][8][9] Its main clinical applications include diagnosis, risk stratification, identification of patient candidates for liver resection for hepatocellular carcinoma, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension and chronic liver disease. [4][5][6][7]10,11 The technique to obtain HVPG values is relatively straightforward; however, specific guidelines must be followed to achieve accurate measurements, as emphasized in recent studies. 1,2,12 The HVPG represents the pressure gradient between the portal vein and the inferior vena cava pressure (IVCP) and, therefore, represents the portal perfusion pressure.…”

Hepatic venous pressure gradient in 2010: Optimal measurement is key

“…However, even patients who do not achieve these targets have some protection from bleeding. 19,20 Importantly, lesser reductions in HVPG 21 are also associated with a reduction in both mortality and other complications of cirrhosis, such as spontaneous bacterial peritonitis 22 and encephalopathy, 23,24 which can be independent of any concomitant improvement in liver function. 25 The aforementioned studies demonstrate the utility of measuring HVPG.…”