Clinical utility of hepatic venous pressure gradient for predicting outcome and guiding treatment of cirrhosis and portal hypertension

Measurement of the hepatic venous pressure gradient (HVPG) remains the most commonly used method to assess portal hypertension (clinically defined as above the normal range of 1-5 mm Hg). HVPG measurement can also serve as a predictor of variceal bleeding (increased risk associated with ＞10-12 mm Hg) and as a prognostic indicator by which treating physicians may design appropriate therapeutic strategies for primary and secondary prophylaxis. The current treatments aim to reduce the HVPG to ＜12 mm Hg or achieve a 20% reduction from baseline, both of which are associated with significantly lower risk of variceal bleeding and rebleeding. For primary prevention, non-selective beta-blockers, such as propranolol, are currently used; however, rebleeding incidence remains high and is frequently treated by a combination of drugs, including the non-selective beta-blockers, and endoscopic management, such as transjugular intrahepatic portosystemic shunting, endoscopic sclerotherapy, and endoscopic band ligation. We discuss the current HVPG measurement methods as well as the clinical applications, detailing its potential as a prognostic indicator of variceal bleeding and rebleeding in various liver conditions, such as cirrhosis, and in response to treatment