Although it is assumed that hemodynamic responders to pharmacological therapy after a variceal hemorrhage are adequately protected from rebleeding, there is no evidence that either this response or its protective effect extend beyond the usual 2‐year follow‐up featured in available studies. We aimed to assess the maintenance of hemodynamic response and its impact on outcomes in a large cohort of hemodynamic responders during a long follow‐up. One hundred three patients with cirrhosis admitted with acute variceal bleeding between 2001 and 2010 were prospectively evaluated. The hepatic venous pressure gradient (HVPG) was determined 5 days after the bleeding and repeated 5‐7 days after maximal tolerated doses of nadolol and nitrates. Hemodynamic responders (HVPG ≤12 mm Hg or ≥20% decrease from baseline) were maintained on drugs and followed up with annual HVPG measurements. Forty‐eight patients (47%) were hemodynamic responders. The median follow‐up was 48 months (range, 2‐108 months). Long‐term HVPG evaluations could not be performed in eight patients (four deaths, two rebleedings, two follow‐ups <1 year). Among the remaining 40 patients, hemodynamic response was maintained in 26 (65%) and lost in 14 (35%). There were no baseline differences between the two subgroups. However, 100% of alcoholic patients who remained abstinent maintained long‐term response, compared with 36% of nonabstinent alcoholics and 50% of patients with viral cirrhosis. Patients with loss of hemodynamic response rebled more during follow‐up and showed a higher incidence of death or liver transplantation. Conclusions: After variceal bleeding, long‐term maintenance of hemodynamic response to drug therapy is mainly restricted to patients with alcoholic cirrhosis who remain abstinent. The loss of this long‐term response carries worse clinical outcomes. (HEPATOLOGY 2012)

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