Pharmacologic Management of Portal Hypertension

Chalermrat Bunchorntavakul; K Rajender Reddy

doi:10.1016/j.cld.2019.06.004

Pharmacologic Management of Portal Hypertension

Clin Liver Dis. 2019 Nov;23(4):713-736. doi: 10.1016/j.cld.2019.06.004. Epub 2019 Aug 7.

Authors

Chalermrat Bunchorntavakul¹, K Rajender Reddy²

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand; Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA.
² Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address: rajender.reddy@uphs.upenn.edu.

PMID: 31563219
DOI: 10.1016/j.cld.2019.06.004

Abstract

Terlipressin, somatostatin, or octreotide are recommended as pharmacologic treatment of acute variceal hemorrhage. Nonselective β-blockers decrease the risk of variceal hemorrhage and hepatic decompensation, particularly in those 30% to 40% of patients with good hemodynamic response. Carvedilol, statins, and anticoagulants are promising agents in the management of portal hypertension. Recent advances in the pharmacologic treatment of portal hypertension have mainly focused on modifying an increased intrahepatic resistance through nitric oxide and/or modulation of vasoactive substances. Several novel pharmacologic agents for portal hypertension are being evaluated in humans.

Keywords: Carvedilol; Portal hypertension; Propranolol; Somatostatin; Terlipressin; Variceal hemorrhage.

Publication types

Review

MeSH terms

Adrenergic alpha-1 Receptor Antagonists / therapeutic use
Adrenergic beta-Antagonists / therapeutic use*
Anticoagulants / therapeutic use*
Antihypertensive Agents / therapeutic use*
Carvedilol / therapeutic use
Esophageal and Gastric Varices / etiology
Gastrointestinal Agents / therapeutic use*
Gastrointestinal Hemorrhage / etiology
Gastrointestinal Hemorrhage / prevention & control*
Gastrointestinal Hemorrhage / therapy
Hemostasis, Endoscopic
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Hypertension, Portal / complications
Hypertension, Portal / drug therapy*
Nitrates / therapeutic use
Octreotide / therapeutic use
Propranolol / therapeutic use
Somatostatin / therapeutic use
Terlipressin / therapeutic use
Vasodilator Agents / therapeutic use*

Substances

Adrenergic alpha-1 Receptor Antagonists
Adrenergic beta-Antagonists
Anticoagulants
Antihypertensive Agents
Gastrointestinal Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Nitrates
Vasodilator Agents
Carvedilol
Somatostatin
Terlipressin
Propranolol
Octreotide