HVPG Measurements as a Surrogate of Clinical Events in Cirrhosis: Experience from Clinical Trials

Abstract

Update current knowledge of the use of hepatic venous pressure gradient (HVPG) as a predictor of clinical events and of efficacy of therapy for portal hypertension. HVPG is a good predictor of clinical events. Decrease in HVPG during therapy is accompanied by a decreased incidence of complications from portal hypertension and improved survival. HVPG measurements are a valuable tool in the management of portal hypertension in cirrhosis. In addition of detecting and grading the severity of portal hypertension, HVPG measurements provide robust prognostic information on the risk of complications, disease progression/regression, and survival. Changes in HVPG in response to therapy predict the effects on clinical outcomes, both during treatment with beta-blockers and when treating HCV-related cirrhosis with specific antivirals. This has led to suggest that HVPG can be used as a surrogate for clinical events when developing new therapies for portal hypertension. Limitations of this approach are discussed.