{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:34:39Z","timestamp":1787168079162,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":5417,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2000,11]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      In the prevention of variceal rebleeding, it is already established that hemodynamic response to drug treatment (decrease in hepatic venous pressure gradient [HVPG] to 12 mm Hg or by &gt;20%) is predictive of clinical effectiveness. In primary prophylaxis very few clinical data are available. We assessed the role of the hemodynamic response to beta\u2013blockers or beta\u2013blockers plus nitrates in predicting clinical efficacy of prophylaxis. A total of 49 cirrhotic patients with varices at risk of bleeding, without prior variceal bleeding, were investigated by hepatic vein catheterization before and after 1 to 3 months of chronic treatment with nadolol or nadolol plus isosorbide mononitrate, and were followed during treatment for up to 5 years. A total of 30 patients (61%) were good hemodynamic responders, and among them in 12 (24%) HVPG was \u226412 mm Hg during treatment. During treatment 9 patients had variceal bleeding: 7 were poor responders and 2 were good responders. The probability of bleeding at 3 years of follow\u2013up was significantly higher in poor responders (41%) than in good responders (7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0008). No patient reaching an HVPG of 12 mm Hg or less during treatment had variceal bleeding during follow\u2013up. Cox's regression analysis showed that poor hemodynamic response was the main factor predicting bleeding (\u03b2 = 1.91; SE(\u03b2) = 0.80;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01). During follow\u2013up 11 patients died of hepatic causes. Survival was related to Child\u2013Pugh class and to initial value of HVPG, according to Cox's analysis. In conclusion, the assessment of hemodynamic response to drugs in terms of HVPG is the best predictor of efficacy of prophylaxis of variceal bleeding in patients treated with beta\u2013blockers or beta\u2013blockers plus nitrates.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1053\/jhep.2000.19322","type":"journal-article","created":{"date-parts":[[2003,6,21]],"date-time":"2003-06-21T10:16:51Z","timestamp":1056190611000},"page":"930-934","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":209,"title":["The Hemodynamic Response to Medical Treatment of Portal Hypertension As A Predictor of Clinical Effectiveness in the Primary Prophylaxis of Variceal Bleeding in Cirrhosis"],"prefix":"10.1097","volume":"32","author":[{"given":"Carlo","family":"Merkel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Bolognesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sacerdoti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Bombonato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bellini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Bighin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Gatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"10.1053\/jhep.2000.19322-BIB1","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1056\/NEJM199105303242202","volume":"324","author":"Poynard","year":"1991","journal-title":"N 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