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. 2023 Mar;22(1):44-50.
doi: 10.1007/s11901-023-00600-z. Epub 2023 Feb 20.

Pharmacotherapies for Portal Hypertension: Current Status and Expanding Indications

Mohamed A Elfeki  1 , Ashwani K Singal  1   2   3 , Patrick S Kamath  4
Affiliations

Pharmacotherapies for Portal Hypertension: Current Status and Expanding Indications

Mohamed A Elfeki et al. Curr Hepatol Rep. 2023 Mar.

Abstract

Purpose: Non-selective beta blockers remain pharmacotherapy of choice for prevention of first episode of variceal bleeding (primary prevention) and for prevention of its recurrence after initial hemostasis (secondary prophylaxis). This review will update the current and emerging pharmacological therapies for portal hypertension.

Recent findings: Data have emerged on carvedilol in preventing hepatic decompensation and improving patient survival among patients with clinically significant portal hypertension. Because measurement of WHVP is invasive and not feasible in routine practice, non-invasive tests with liver stiffness measurement in combination with platelet count may be accurate in identifying clinically significant portal hypertension.

Summary: Carvedilol is more effective in reducing portal pressure compared to nadolol or propranolol. Its use has expanded to reduce risk of hepatic decompensation among patients with CSPH, which can be identified non-invasively using liver stiffness and platelet count. Studies are needed on non-invasive biomarkers to guide and optimize pharmacological treatment of portal hypertension.

Keywords: Baveno; CSPH; Carvedilol; Cirrhosis; Decompesation; Liver stiffness.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Pathophysiology of portal hypertension.
Figure 2
Figure 2
Non-invasive assessment of clinically significant portal hypertension (CSPH) in patients with compensated cirrhosis.
See this image and copyright information in PMC

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