Original Contribution
The American Journal of Gastroenterology (2006) 101, 506–512; doi:10.1111/j.1572-0241.2006.00453.x
Pharmacological Reduction of Portal Pressure and Long-Term Risk of First Variceal Bleeding in Patients with Cirrhosis
Juan Turnes MD1, Juan Carlos Garcia-Pagan MD1, Juan G Abraldes MD1, Manuel Hernandez-Guerra MD1, Alessandra Dell'Era MD1 and Jaime Bosch MD1
1Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Correspondence: Juan Carlos Garcia-Pagan, MD, Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain
Received 13 May 2005; Revised 0000; Accepted 26 October 2005.
Abstract
OBJECTIVES:
A reduction in hepatic venous pressure gradient (HVPG) of 
20% of baseline or to 
12 mmHg (responders) is associated with a reduced risk of first variceal bleeding. The aim of this study was to evaluate whether this protective effect is maintained in the long term and if it extends to other portal hypertension complications.
METHODS:
Seventy-one cirrhotic patients with esophageal varices and without previous variceal bleeding who entered into a program of prophylactic pharmacological therapy and were followed for up to 8 yr were evaluated. All had two separate HVPG measurements, at baseline and after pharmacological therapy with propranolol 
isosorbide mononitrate.
RESULTS:
Forty-six patients were nonresponders and 25 were responders. Eight-year cumulative probability of being free of first variceal bleeding was higher in responders than in nonresponders (90%vs 45%, p= 0.026). The lack of hemodynamic response and low platelet count were the only independent predictors of first variceal bleeding. Additionally, reduction of HVPG was independently associated with a decreased risk of spontaneous bacterial peritonitis (SBP) or bacteremia. No significant differences in the development of ascites, hepatic encephalopathy, or survival were observed.
CONCLUSIONS:
The hemodynamic response in cirrhotic patients is associated with a sustained reduction in the risk of first variceal bleeding over a long-term follow-up. Reduction of HVPG also correlate with a reduced risk of SBP or bacteremia.
