Hepatic venous pressure gradient: the facts

  • Julio D. Vorobioff
  • Juan G. Abraldes
  • Roberto J. Groszmann


Many of the clinical complications of cirrhosis are the direct consequences of the elevation of portal venous pressure (PVP). Portal hypertension is defined as a PVP of greater than the normal 5–10 mmHg. The degree of portal hypertension has been shown to correlate with the severity of liver disease, both functionally1 and histologically2, 3. However, direct portal venous measurement is invasive and cannot be routinely performed. As a surrogate, hepatic venous pressure gradient (HVPG) has been widely accepted as a measurement for PVP. The ease and safety of HVPG measurement has made it a valuable tool not only in the research arena, but also more and more in clinical practice.


Portal Hypertension Hepatic Vein Cirrhotic Patient Esophageal Varix Variceal Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Braillon A, Cales P, Valla D, Gaudy D, Geoffroy P, Lebrec D. Inftuenece of the degree of liver failure on systemic and splanchnic hemodynamics and on response to propranolol in patients with cirrhosis. Gut. 1986:27:1204–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Krogsgaard K, Gluud C, Henriksen JH, Christoffersen P. Correlation between liver morphology and portal pressure in alcoholic liver disease. Hepatology. 1984:4:699–703.PubMedCrossRefGoogle Scholar
  3. 3.
    Picchiotti R, Mingazzini PL, Scucchi L et al. Correlations between sinusoidal pressure and liver morphology in cirrhosis. J Hepatol. 1994:20:364–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Hallion L, Francois-Frank CA. Recherches experimentales executees a I’aide d’um novel appareil volumetrique sur I’innervation vaso-motrice de l’intestin. Arch Physiol Norm Pathol. 1896:8:493–508.Google Scholar
  5. 5.
    Thompson WP, Caughey JL, Whipple AO et al. Splenic vein pressure and congestive splenomegaly (Banty’s syndrome). J Clin Invest. 1937:16:571.PubMedCrossRefGoogle Scholar
  6. 6.
    Myers JD, Taylor WJ. An estimation of PVP by occlusive catheterization of a hepatic venule. J Clin Invest. 1991:30:662–3.Google Scholar
  7. 7.
    Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology. 2004:39:280–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Groszmann RJ, Glickman MC, Blei AT, Storer E, Conn HO. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology. 1979:76:253–8.PubMedGoogle Scholar
  9. 9.
    Bosch J, Mastai R, Kravetz D, Navasa M. Rodes J. Hemodynamic evaluation of patients with portal hypertension. Semin Liver Dis. 1986:6:309–17.PubMedCrossRefGoogle Scholar
  10. 10.
    Seinlauf AF, García-Tsao G, Gupta T, Dickey K, Zakko MF, Groszmann RJ. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatology. 1999:29:1070–3.CrossRefGoogle Scholar
  11. 11.
    Groszmann RJ, de Franchis R. Portal hypertension. In: Schiff ER, Sorrell MF, Maddrey W, editors. Schiff’s Diseases of the Liver. Philadelphia: Lippincott-Raven, 1999:387–442.Google Scholar
  12. 12.
    Boyer TD, Triger DR, Horisawa M, Redeker AG, Reynolds TB. Direct transhepatic measurement of portal vein pressure using a thin needle: comparison with wedged hepatic venous pressure. Gastroenterology. 1977:72:584–9.PubMedGoogle Scholar
  13. 13.
    Groszmann RJ, Atterbury CE. Clinical applications of the measurement of portal venous pressure. J Clin Gastroenterol. 1980:2:379–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Pomier-Layrargues G, Kusielewicz D, Willems B et al. Presinusoidal portal hypertension in non-alcoholic cirrhosis. Hepatology. 1985:5:415–18.PubMedCrossRefGoogle Scholar
  15. 15.
    Perello A, Escorsell A, Bru C et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology. 1999:30:1393–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Deplano A, Migaleddu V, Pischedda A et al. Portohepatic gradient and portal hemodynamics in patients with cirrhosis due to hepatitis C virus infection. Dig Dis Sci. 1999:44:155–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Loureiro-Silva MR, Cadelina GW, Groszmann RJ. Deficit in nitric oxide production in cirrhotic rat livers is located in the sinusoidal and postsinusoidal areas. Am J Physiol Gastrointest Liver Physiol. 2003:284:G567–74.PubMedGoogle Scholar
  18. 18.
    Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology. 1987:7:660–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Arroyo V, Bosch J, Gaya-Beltran J et al. Plasma renin activity and urinary sodium excretion as prognostic indicators in nonazotemic cirrhosis with ascites. Ann Intern Med. 1981:94: 198–201.PubMedGoogle Scholar
  20. 20.
    Vinel JP, Cassigneul J, Louis A, Levade M, Pascal JP. Clinical and prognostic significance of portohepatic gradient in patients with cirhosis. Surg Gynecol Ohstet. 1982:155:347–52.Google Scholar
  21. 21.
    Vinel JP, Cassigneul J, Levade M, Voigt JJ, Pascal JP. Assessment of short-term prognosis after variceal bleeding in patients with alcoholic cirrhosis by early measurement of portohepatic gradient. Hepatology. 1986:6:116–17.PubMedCrossRefGoogle Scholar
  22. 22.
    Gluud C, Henriksen JH, Nielsen G. Prognostic indicators in alcoholic cirrhotic men. Hepatology. 1988:8:222–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Tage-Jensen U, Henriksen JH, Christensen E, Widding A, Ring-Larsen H, Christensen NJ. Plasma catecholamine level and portal venous pressure as guides to prognosis in patients with cirrhosis. J Hepatol. 1988:6:350–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Groszmann RJ, Bosch J, Grace N et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology. 1990:99:1401–7.PubMedGoogle Scholar
  25. 25.
    Merkel C, Bolognesi M, Bellon S et al. Prognostic usefulness of hepatic vein catheterization in patients with cirrhosis and esophageal varices. Gastroenterology. 1992:102:973–9.PubMedGoogle Scholar
  26. 26.
    Vorobioff J, Groszmann RJ, Picabea E et al. Prognostic value of hepatic venous pressure measurement in alcoholic cirrhosis: A ten year prospective study. Gastroenterology. 1996:111:701–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Villanueva C, Aracil C, Lopez-Balaguer JM, Balanzo J. Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rcbleeding. N Engl J Med. 1996:334:1624–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Patch D, Armonis A, Sabin C et al. Single portal pressure measurement predicts survival in cirrhotic patients with recent bleeding. Gut. 1999:44:264–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Moitinho E, Escorsell A, Bandi JC et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999:117:626–31.PubMedCrossRefGoogle Scholar
  30. 30.
    Abraldes JG, Tarantino I, Turnes J Garcia-Pagan JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology. 2003:37:902–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Urbain D, Muls V, Makhoul E, Jeghers O, Thys O, Ham HR. Prognostic significance of hepatic venous pressure gradient in medically treated alcoholic cirrhosis: comparison to aminopyrine breath test. Am J Gastroenterol. 1993:88:856–9.PubMedGoogle Scholar
  32. 32.
    Pomier-Layrargues G, Villeneuve JP, Willems B, Huet PM, Marleau D. Systemic and hepatic hemodynamics after variceal hemorrhage: effects of propranolol and placebo. Gastroenterology. 1987:93:1218–24.PubMedGoogle Scholar
  33. 33.
    Groszmann, RJ, Garcia-Tsao G, Makuch R et al. Multicenter randomized placebo-controlled trial of non-selective beta-blockers in the prevention of the complications of portal hypertension: final results and identification of a predictive factor. Hepatology. 2003:38 (Suppl. 1):206A (abstract).CrossRefGoogle Scholar
  34. 34.
    García-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985:5:419–24.PubMedCrossRefGoogle Scholar
  35. 35.
    Rigau J, Bosch J, Bordas JM et al. Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage. Gastroenterology. 1989:96: 873–80.PubMedGoogle Scholar
  36. 36.
    Viallet A, Marleau D, Huet M et al. Hemodynamic evaluation of patients with intrahepatic portal hypertension. Relationship between bleeding varices and the porto hepatic gradient. Gastroenterology. 1975:69: 1297–300.PubMedGoogle Scholar
  37. 37.
    Christensen U, Sorensen TI, Jensen LI, Aagaard J, Burcharth F. The free portal pressure in awake patients with and without cirrhosis of the liver. Liver. 1983:3:147–50.PubMedGoogle Scholar
  38. 38.
    Viola C, Bosch J, Mastai R et al. Prognostic value of measurements of portal pressure in patients with cirrhosis. J Hepatol. 1987:5(Suppl. 1):S71 (abstract).Google Scholar
  39. 39.
    Vlavianos P, Gimson AES, Hayllar K et al. Prognostic significance of systemic and portal hemodynamic parameters in patients with cirrosis and previous variceal bleeding. Gut. 1990:31:A592 (abstract).Google Scholar
  40. 40.
    Lebrec D, De Fleury P, Rueff B, Nahum H, Benhamou JP. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980:79:1139–44.PubMedGoogle Scholar
  41. 41.
    Adamson RJ, Butt K, Dennis CR et al. Prognostic significance of portal pressure in patients with bleeding esophageal varices. Surg Gynecol Obstet. 1977:145:353–6.Google Scholar
  42. 42.
    Ready JB, Robertson AD, Goff JS, Rector WG Jr. Assessment of the risk of bleeding from esophageal varices by continuous monitoring of portal pressure. Gastroenterology. 1991:100:1403–10.PubMedGoogle Scholar
  43. 43.
    Westaby D, Polson RJ, Gimson AE, Hayes PC, Hayllar K, Williams R. A controlled trial of oral propranolol compared with injection sclerotherapy for the long-term management of variceal bleeding. Hepatology. 1990:11:353–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Villanueva C, Ortiz J, Miñana J et al. Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding. Gastroenterology. 2001:121:110–17.PubMedCrossRefGoogle Scholar
  45. 45.
    Leevy CM, Zinke M, Baber J, Chey WY. Observations on the influence of medical therapy on portal hypertension in hepatic cirrhosis. Ann Intern Med. 1958:49:837–51.PubMedGoogle Scholar
  46. 46.
    Reynolds TB, Geller HM, Kuzma OT, Redeker AG. Spontaneous decrease in portal pressure with clinical improvement in cirrhosis. N Engl J Med. 1960;263:734–9.PubMedCrossRefGoogle Scholar
  47. 47.
    D’Amico G, García-Tsao G, Calès P et al. Diagnosis of portal hypertension. How and when? In: de Franchis R, editor. Portal Hypertension. III. Proceedings of the Third Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies. Oxford: Blackwell Science, 2001:36–63.Google Scholar
  48. 48.
    Morali GA, Sniderman KW, Deitel KM et al. Is sinusoidal portal hypertension a necessary factor for the development of hepatic ascites? J Hepatol. 1992:16:249–50.PubMedCrossRefGoogle Scholar
  49. 49.
    Rector WG Jr. Portal hypertension: a permissive factor only in the development of ascites and variceal bleeding. Liver. 1986:6:221–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Bosch J, Mastai R, Kravetz D, Navasa M, Rodes J. Hemodynamic evaluation of the patient with portal hypertension. Semin Liver Dis. 1986:6:309 17.PubMedCrossRefGoogle Scholar
  51. 51.
    Feu F, García-Pagán JC, Bosch J et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal hemorrhage in patients with cirrhosis. Lancet. 1995:346:1056–9.PubMedCrossRefGoogle Scholar
  52. 52.
    McCormick PA, Patch D, Greenslade L, Chin J, McIntyre N, Burroughs AK. Clinical vs hemodynamic response to drugs in portal hypertension. J Hepatol. 1998:28:1015–19.PubMedCrossRefGoogle Scholar
  53. 53.
    Villanueva C, Minana J, Ortiz J et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med. 2001:345:647–55.PubMedCrossRefGoogle Scholar
  54. 54.
    Merkel C, Bolognesi M, Sacerdoti D et al. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology. 2000:32:930–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Bureau C, Péron JM, Alric L et al. “A la carte” treatment of portal hypertension: adapting medical therapy to hemodynamic response for the prevention of bleeding. Hepatology. 2002:36:1361–6.PubMedGoogle Scholar
  56. 56.
    Patch D, Sabin CA, Goulis J et al. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology. 2002:123:1013–19.PubMedCrossRefGoogle Scholar
  57. 57.
    Groszmann RJ, Garcïa-Tsao G. Endoscopic variceal banding vs pharmacological therapy for the prevention of recurrent variceal hemorrhage: what makes the difference? Gastroenterology. 2002:123:1388–91.PubMedCrossRefGoogle Scholar
  58. 58.
    Burroughs AK, Groszmann RJ, Bosch J et al. Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure a better end point? Gut. 2002:50:425–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Friedman LS, Maddrey WC. Surgery in the patient with liver disease. Med Clin N Am. 1987:71:453–76.PubMedGoogle Scholar
  60. 60.
    Bruix J, Castells A, Bosch J et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients. Prognostic value of preoperative portal pressure. Gastroenterology. 1996: 111:1018–22.PubMedCrossRefGoogle Scholar
  61. 61.
    Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999:30:1434–40.PubMedCrossRefGoogle Scholar
  62. 62.
    Lovet JM, Bruix J, Fuster J et al. Liver transplantation for small hepatocellular carcinoma: the tumor-node-metastasis classification does not have prognosis power. Hepatology. 1998:27: 1572–7.CrossRefGoogle Scholar
  63. 63.
    Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996:334:693–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg. 1993: 218:145–51.PubMedCrossRefGoogle Scholar
  65. 65.
    Groszmann RJ. The hepatic venous pressure gradient: has the time arrived for its application in clinical practice? Hepatology. 1996:24:739–41.PubMedCrossRefGoogle Scholar
  66. 66.
    Thalheimer U, Mela M, Patch D, Burroughs AK. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence. Gut. 2004:53:143–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Huet PM, Pomier-Layrargues G. The hepatic venous pressure gradient: “remixed and revisited”. Hepatology. 2004:39:295–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2004

Authors and Affiliations

  • Julio D. Vorobioff
  • Juan G. Abraldes
  • Roberto J. Groszmann
    • 1
  1. 1.VA Connecticut Healthcare SystemHepatic Hemodynamic Laboratory/111JWest HavenUSA

Personalised recommendations