Targeting portal pressure measurements: A critical reappraisal

Many of the complications of cirrhosis reflect the presence of portal hypertension, which is commonly expressed as the hepatic venous pressure gradient (HVPG). Baseline and repeat measurements of HVPG have been recommended for the management of patients with cirrhosis in the setting of pharmacologic prophylaxis of variceal bleeding and for gaining information about prognosis. However, published studies have demonstrated problems with the interpretation of the data on HVPG monitoring, making its use controversial. We view the current data as insufficient evidence to support the monitoring of a targeted reduction of HVPG as routine clinical practice. We recommend the performance of new prospective studies to establish the clinical importance of HVPG measurements. (HEPATOLOGY 2004;39:386–290.)