Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis.
OBJECTIVE
Following treatment with beta blockers in patients with cirrhosis and portal hypertension, reduction of hepatic venous pressure gradient (HVPG) to <12 mmHg or by >20% of baseline induces an extremely low risk of variceal bleeding. However, several factors such as compliance to therapy or alcohol abstinence may change the initial response after a long follow-up, and the effect of response on other complications of cirrhosis is less clear. The aim of this study was to assess the long-term maintenance of hemodynamic response and its influence on complications of cirrhosis.


METHODS
One hundred and thirty two cirrhotic patients received nadolol and isosorbide mononitrate to prevent variceal rebleeding. HVPG was measured at baseline, after 1 to 3 months under treatment and again 12 to 18 months later.


RESULTS
Sixty four patients were responders. After a longer follow-up, earlier response did not change in 81% of cases. Changes of response were mainly related to modifications in medication dose or in alcohol intake. As compared with poor-responders, responders had a lower probability of developing ascites (P<0.001) and related conditions, a greater improvement of Child-Pugh score (P=0.03), and a lower likelihood of developing encephalopathy (P=0.001) and of requiring liver transplantation (P=0.002). Eleven responders and 22 poor-responders died (P=0.029).


CONCLUSIONS
Hemodynamic response to treatment of portal hypertension is usually sustained after a long-term follow-up. Response decreases the probability of developing complications of cirrhosis and the need for liver transplantation, and significantly improves survival.
Villanueva
Càndid
C
Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Avgda. Sant Antoni M? Claret, 167, 08025 Barcelona, Spain. cvillanueva@hsp.santpau.es
López-Balaguer
Josep M
JM
Aracil
Carles
C
Kolle
Lilian
L
González
Begoña
B
Miñana
Josep
J
Soriano
German
G
Guarner
Carlos
C
Balanzó
Joaquim
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001201:Ascites / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D007548:Isosorbide Dinitrate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000627:therapeutic use; D011379:Prognosis
D000319:Adrenergic beta-Antagonists; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate