Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis

Hepatology. 2003 Apr;37(4):902-8. doi: 10.1053/jhep.2003.50133.


In cirrhotic patients under pharmacologic treatment for portal hypertension, a reduction in hepatic venous pressure gradient (HVPG) of >or=20% of baseline or to <or=12 mm Hg markedly reduces the risk of variceal rebleeding. This study was aimed at evaluating whether these hemodynamic targets also prevent other complications of portal hypertension and improve long-term survival. One hundred five cirrhotic patients included in prospective trials for the prevention of variceal rebleeding were studied. Seventy-three of the patients had 2 separate HVPG measurements, at baseline and under pharmacologic therapy with propranolol +/- isosorbide mononitrate. Patients were followed for up to 8 years. Survival and risk of developing portal hypertension-related complications were compared between responders and nonresponders. Twenty-eight patients showed a reduction of HVPG >or=20% of baseline or to <or=12 mm Hg (responders), and 45 patients were nonresponders. Nonresponders had a significantly greater risk of developing variceal rebleeding (P =.013), ascites (P =.025), spontaneous bacterial peritonitis (P =.003), hepatorenal syndrome (P =.026), and hepatic encephalopathy (P =.024) than responders. Eight-year cumulative probability of survival was significantly lower in nonresponders than in responders (52% vs. 95%, respectively, P =.003). At multivariate analysis, being a nonresponder was independently associated with the risk of developing rebleeding, ascites, spontaneous bacterial peritonitis, and lower survival. In conclusion, in cirrhotic patients receiving pharmacologic treatment for prevention of variceal rebleeding, a decrease in HVPG >or=20% or to <or=12 mm Hg is associated with a marked reduction in the long-term risk of developing complications of portal hypertension and with improved survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / therapeutic use*
  • Ascites / etiology
  • Bacterial Infections / etiology
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • Hemodynamics / drug effects*
  • Hemorrhage / etiology
  • Hemorrhage / physiopathology
  • Hepatic Encephalopathy / etiology
  • Hepatorenal Syndrome / etiology
  • Humans
  • Hypertension, Portal / drug therapy*
  • Hypertension, Portal / etiology*
  • Hypertension, Portal / physiopathology
  • Isosorbide Dinitrate / analogs & derivatives*
  • Isosorbide Dinitrate / therapeutic use*
  • Liver Cirrhosis / complications*
  • Male
  • Middle Aged
  • Peritonitis / microbiology
  • Probability
  • Prognosis
  • Propranolol / therapeutic use*
  • Recurrence
  • Risk Factors
  • Survival Analysis
  • Time Factors
  • Varicose Veins / complications
  • Vasodilator Agents / therapeutic use*


  • Antihypertensive Agents
  • Vasodilator Agents
  • Propranolol
  • Isosorbide Dinitrate
  • isosorbide-5-mononitrate