Effect of propranolol on hemodynamics and its clinical significance in patients with portal hypertension

Objective To investigate whether short-term oral administration of propranolol can induce hemodynamic response in patients with liver cirrhosis and esophageal and gastric varices, as well as the clinical significance of such response in the prevention of esophagogastric variceal bleeding ( EGVB) . Methods A total of 42 cirrhotic patients with esophageal and gastric varices who were treated in Department of Gastroenterology in Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2015 to October 2016 were enrolled. Hepatic venous pressure gradient ( HVPG) was measured before and after 7 days of oral administration of propranolol. The patients who completed these two HVPG measurements were followed up until the development of EGVB. Hemodynamic response was defined as a reduction in HVPG by at least 20% or an absolute value of HVPG of ≤12 mm Hg. The paired samples t-test and the chi-square test were used to compare the change in HVPG after propranolol administration and the incidence of EGVB between responders and non-responders.A regression analysis was used to identify the independent risk factors for EGVB. Results A total of 32 patients were included in the final analysis, with an overall response rate of 43. 75% ( 14 responders and 18 non-responders) , and the overall HVPG value decreased from18. 3 ± 5. 0 mm Hg to 15. 0 ± 4. 9 mm Hg ( t = 4. 640, P < 0. 001) . There were no significant differences in age, sex, etiology, liver function, and baseline HVPG between the responders and the non-responders ( all P > 0. 05) , and the responders had a significantly higher HVPG value at the second time of measurement than the non-responders ( 11. 5 ± 3. 5 mm Hg vs 17. 7 ± 5. 0 mm Hg, t = 5. 470, P <0. 001) . During the 3-year follow-up, 8 patients developed EGVB, and the responders had a significantly lower incidence rate of EGVB than the non-responders ( χ2= 8. 529, P = 0. 004) . The multivariate Cox regression analysis showed that a past history of bleeding ( hazard ratio [HR]= 12. 917, 95% confidence interval [CI]: 1. 861-89. 648, P = 0. 010) and HVPG value at the second time of measurement ( HR = 1. 481, 95% CI: 1. 102-1. 990, P = 0. 009) were independent risk factors for EGVB. Conclusion The rate of hemodynamic response in cirrhotic patients with esophageal and gastric varices is 43. 75% after short-term oral administration of propranolol. Responders have a significantly lower risk of EGVB than non-responders. Patients with a past history of bleeding or a high HVPG value at the second time of measurement have an increased risk of bleeding.