Nonselective β–Blockers Plus Nitrates in Portal Hypertension: An Open Question

Merkel, Carlo

doi:10.1053/jhep.2003.50274

Cited by 6 publications

(3 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, all the reported side effects due to ISMN disappeared promptly after discontinuation of the drug with no deterioration of renal function or worsening of control of ascites. 22 In our study, we found that addition of ISMN was safe, with minor adverse effects in one sixth of patients that disappeared with dose reduction. Thus our study suggests that the combination of beta-blocker and ISMN for primary prophylaxis appears to be more effective and safe.…”

Section: Discussionmentioning

confidence: 49%

See 1 more Smart Citation

Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with ‘high‐risk’ varices

Sharma

Kumar

Sharma

et al. 2009

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 55%

Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with ‘high‐risk’ varices

Sharma

Kumar

Sharma

et al. 2009

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Clinical trials in humans support the role of nitrates to reduce risk of variceal hemorrhage, when used in combination with beta-blockers [27,28]. However, nitrates alone may have a detrimental effect on mortality in cirrhotic patients, with exacerbation of the hyperdynamic circulation and poor tolerance [29].…”

Section: No For Therapy Of Increased Intrahepatic Resistancementioning

confidence: 99%

Nitric oxide and portal hypertension: Interface of vasoreactivity and angiogenesis

Langer

Shah

2006

Journal of Hepatology

View full text Add to dashboard Cite

Changing clinical practice with measurements of portal pressure

Boyer

2004

Hepatology

View full text Add to dashboard Cite

O ver the last two decades, our understanding of the treatment and prognosis of portal hypertension has continued to improve. 1,2 The use of techniques to measure the wedged hepatic venous pressure (WHVP), developed more than 50 years ago, has played a major role in elucidating the pathophysiology of the syndrome 3 and, consequently, in developing currently available pharmacologic therapy. Recently, a role for measurements of WHVP has also been proposed in evaluating the progression of chronic liver diseases. 4 This measurement has been shown to be the best predictor of the development of complications of portal hypertension in patients with early cirrhosis. 5 Investigators in this area of research need not be convinced about the importance of the WHVP technique in advancing our knowledge of portal hypertension from the experimental arena 3 to current clinical applications. 6 -8 However, there is an unanswered question that has lingered with us for more than 20 years: Should measurement of WHVP be incorporated into clinical practice?To begin to answer this question, we must assure ourselves that the technique is executed properly. In a recent study performed to evaluate a new pharmaceutical agent, one of us (R.J.G.) was asked to be a blind reviewer of WHVP tracings performed by centers experienced in the measurement of WHVP. Even though minimal criteria for acceptable measurements have been established (Table 1), approximately 30% of studies% had to be rejected as the tracings obtained were uninterpretable. Our experience is not unique (Jaime Bosch, personal communication). We cannot draw conclusions about the usefulness of this technique in a clinical setting if investigational studies designed to answer the question do not themselves comply with minimal criteria for technical adequacy. To achieve results that are consistent and comparable from center to center, meticulous attention to detail is required ( Table 1).Direct measurement of portal venous pressure (PVP) is invasive and inconvenient. In 1951, Myers and Taylor 9 first described WHVP, which is the measurement of the sinusoidal pressure, an indirect measurement of PVP. Since then, WHVP has been shown to be very safe and the rate of successful hepatic vein catheterization is greater than 95%. By threading a small catheter into a hepatic vein until it cannot be advanced further, a "wedged" hepatic venous pressure is obtained. As the hepatic vein is occluded, a continuous column of fluid between the catheter and the sinusoid is formed, resulting in a pressure reading that is equal to the sinusoidal pressure (Fig. 1). In normal livers, the low-resistant sinusoidal network dissipates most of the pressure back up from the wedged catheter. As there is no direct connection, via a static column of fluid, between the catheter and the portal tributaries, the pressure reading of the transducer reflects sinusoidal pressure (in normal livers is slightly lower than portal pressure). This is also observed in presinusoidal causes of portal hypertension such as schisto...

show abstract

Nonselective β–Blockers Plus Nitrates in Portal Hypertension: An Open Question

Cited by 6 publications

References 30 publications

Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with ‘high‐risk’ varices

Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with ‘high‐risk’ varices

Nitric oxide and portal hypertension: Interface of vasoreactivity and angiogenesis

Changing clinical practice with measurements of portal pressure

Contact Info

Product

Resources

About