Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis

• Published in: Journal of hepatology Vol. 40; no. 5; pp. 757 - 765
• Main Authors: Villanueva, Càndid, López-Balaguer, Josep M, Aracil, Carles, Kolle, Lilian, González, Begoña, Miñana, Josep, Soriano, German, Guarner, Carlos, Balanzó, Joaquim
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.05.2004; Elsevier
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Ascites - etiology; Biological and medical sciences; Cirrhosis; Complications of cirrhosis; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - prevention & control; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hemodynamic measurements; Hemodynamics - drug effects; Hepatic Encephalopathy - etiology; Humans; Hypertension, Portal - drug therapy; Hypertension, Portal - etiology; Hypertension, Portal - physiopathology; Isosorbide Dinitrate - analogs & derivatives; Isosorbide Dinitrate - therapeutic use; Liver Circulation - drug effects; Liver Cirrhosis - complications; Liver Cirrhosis - drug therapy; Liver Transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Nadolol - therapeutic use; Other diseases. Semiology; Pharmacological Therapy; Portal hypertension; Prognosis; Cirrhosis; Pharmacological Therapy; Complications of cirrhosis; Hemodynamic measurements; Portal hypertension; Measurement; Therapy; Portal circulation disease; Cardiovascular disease; Hepatic disease; Vascular disease; Response; Maintenance treatment; Gastroenterology; Digestive diseases; Complication; Influence; Hemodynamics
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2004.01.017

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. 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. 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). 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.