Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis.
OBJECTIVE
A reduction in hepatic venous pressure gradient (HVPG) of > or =20% of baseline or to < or =12 mmHg (responders) is associated with a reduced risk of first variceal bleeding. The aim of this study was to evaluate whether this protective effect is maintained in the long term and if it extends to other portal hypertension complications.


METHODS
Seventy-one cirrhotic patients with esophageal varices and without previous variceal bleeding who entered into a program of prophylactic pharmacological therapy and were followed for up to 8 yr were evaluated. All had two separate HVPG measurements, at baseline and after pharmacological therapy with propranolol +/- isosorbide mononitrate.


RESULTS
Forty-six patients were nonresponders and 25 were responders. Eight-year cumulative probability of being free of first variceal bleeding was higher in responders than in nonresponders (90% vs 45%, p= 0.026). The lack of hemodynamic response and low platelet count were the only independent predictors of first variceal bleeding. Additionally, reduction of HVPG was independently associated with a decreased risk of spontaneous bacterial peritonitis (SBP) or bacteremia. No significant differences in the development of ascites, hepatic encephalopathy, or survival were observed.


CONCLUSIONS
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.
Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, University of Barcelona, Villaroel 170, 08036 Barcelona, Spain.
Juan
J
Turnes
Juan Carlos
JC
Garcia-Pagan
Juan G
JG
Abraldes
Manuel
M
Hernandez-Guerra
Alessandra
A
Dell'Era
Jaime
J
Bosch
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000401:mortality; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000401:mortality / Q000517:prevention & control; D017082:Portal Pressure / Q000187:drug effects*; D012306:Risk; D015996:Survival Rate