title: Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis.
abstract: OBJECTIVE
  The use of the hepatic venous pressure gradient (HVPG) to assess the efficacy of the pharmacological treatment of portal hypertension in cirrhosis is controversial. Our aim was to establish whether target HVPG reduction predicts variceal bleeding in cirrhotic patients receiving variceal bleeding prophylaxis.
  
  
  METHODS
  Data sources were MEDLINE, EMBASE, Cochrane Controlled Trials Register, citation lists, and abstracts (most recent search March 2006). Cohorts of patients on drug therapy from randomized and nonrandomized studies correlating variceal bleeding and HVPG change were used. Heterogeneity was explored by metaregression analysis.
  
  
  RESULTS
  Ten studies totaling 595 patients undergoing two HVPG measurements were identified. The RR of bleeding was lower in patients achieving an overall (HVPG <or=12 mmHg or decrease >or=20%) (0.27, 95% CI 0.14-0.52), complete (HVPG <or=12 mmHg) (0.48, CI 0.28-0.81), or partial (HVPG decrease >or=20%) (0.41, CI 0.20-0.81) response, with significant heterogeneity. Regression analysis identified the interval between the HVPG measurements significantly associated with the RR of bleeding. Heterogeneity was no longer significant after exclusion of an outlier trial, which showed the longest interval to HVPG remeasurement and the lowest quality score. Even considering nonvaluable patients because of bleeding as HVPG responders, the RR of bleeding was lower in overall responders than in nonresponders (0.66, CI 0.51-0.86). Overall response was associated with lower liver-related mortality (RR 0.58, CI 0.37-0.91).
  
  
  CONCLUSIONS
  Current evidence supports the validity of HVPG end points to monitor drug therapy efficacy for variceal bleeding prophylaxis. HVPG monitoring also provides valuable prognostic information.
authors: Servicio de Gastroenterología, Hospital Ramón y Cajal, Madrid, Spain.
authors: Agustín
authors: A
authors: Albillos
authors: Rafael
authors: R
authors: Bañares
authors: Mónica
authors: M
authors: González
authors: Cristina
authors: C
authors: Ripoll
authors: Rosario
authors: R
authors: Gonzalez
authors: Maria-Vega
authors: MV
authors: Catalina
authors: Luis-Miguel
authors: LM
authors: Molinero
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000503:physiopathology; D017082:Portal Pressure / Q000187:drug effects*; D012044:Regression Analysis; D014690:Venous Pressure / Q000187:drug effects*
chemical_list: D000959:Antihypertensive Agents