Long-Term Pharmacologic Therapy of Portal Hypertension

Pharmacologic treatment of portal hypertension: Past, present, and future

“…It is important to note that the effective lowering of portal pressure by ␤-blockers requires blockade of both ␤ 1 -cardiac receptors and ␤ 2 -splanchnic receptors. 2,16,17 Therefore, only nonselective ␤-blockers (propranolol, nadolol, and timolol) are effective in lowering portal pressure significantly, and it is the first two agents that have been used in the controlled trials.…”

“…The reason ␤-blocker therapy is not more effective is because as many as two thirds of the patients do not respond to treatment with a 20% decrease in portal pressure or a decrease in the portal-hepatic vein gradient to below 12 mm Hg. 3,17 If the portal-hepatic vein gradient does not fall at least 20% or to less than 12 mm Hg, then the use of ␤-blockers is ineffective in preventing bleeding. 2 There are no noninvasive tests available that measure the response of portal pressure to therapy in an accurate and reproducible manner.…”

A1166C Angiotensin II Type 1 Receptor Gene Polymorphism May Predict Hemodynamic Response to Losartan in Patients with Cirrhosis and Portal Hypertension

“…The aim of the pharmacological treatment in portal hypertension is to achieve a sustained decrease in portal pressure since a reduction in the hepatic venous pressure gradient (HVPG) by more than 20% of baseline values or below 12 mmHg has been associated with a marked reduction in the risk of variceal bleeding or rebleeding (1). Although propranolol is the standard therapy, these goals are achieved only in about 30% of the treated patients (2). Besides, adverse effects and contraindications to β-blockers have stimulated the search of alternative pharmacological treatments.…”