Propranolol treatment of portal hypertension in cirrhosis patients is better the higher the untreated pressure: a single-centre prospective experience

Abstract

Objective. To assess the effect of propranolol treatment on the hepatic venous pressure gradient (HVPG) and the relationship between native HVPG and the effect of propranolol in patients with cirrhosis and portal hypertension in a prospective, observational, single-center study. Material and methods. The HVPG was registered prospectively in 124 consecutive cirrhosis patients with and without treatment with propranolol 80 mg daily. Results. 41% of the patients responded to the treatment with the intended reduction of HVPG to <12 mm Hg and/or by >20%. The HVPG reduction was larger for higher native HVPG values (p < 0.001). There was no significant relation between changes in heart rate and changes in HVPG (p = 0.8). Conclusions. The high fraction of hemodynamic non-responders supports the rationale of measuring the HVPG with and without propranolol treatment to assist the clinical assessment and avoid meaningless and potentially harmful treatment. The positive association between a high native HVPG and propranolol-induced HVPG reduction indicates that pharmacological treatment also benefits patients with advanced portal hypertension.

Key Words::

• adrenergic β-antagonists
• gastric varices
• hepatic venous pressure gradient
• esophageal varices
• portal hypertension

Acknowledgements

The authors are grateful to Gertrud Kiil Jørgensen for help with the database. The study was supported by the Novo Nordisk Foundation.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.