Certain vasoactive substances reduce portal pressure in patients or animals with
portal hypertension by either inducing splanchnic vasoconstriction or reducing hepatic vascular resistance. Studies have shown that
propranolol or
nadolol significantly reduce the risk of a first episode of gastrointestinal (GI)
bleeding and increase the survival rate in patients with
cirrhosis and oesophageal
varices.
Isosorbide-5-mononitrate is also effective in the prevention of
bleeding. The combination of beta-blockers and
nitrates may be more effective than one
drug alone. These results show that
beta-adrenoceptor antagonists must be used to prevent the first episode of GI
bleeding. Beta-blocker administration also significantly reduces the risk of recurrent GI
bleeding and increases the survival rate in patients with
cirrhosis. Studies have shown that
propranolol is as effective as endoscopic
sclerotherapy. The combination of a beta-blocker with endoscopic
sclerotherapy may be more effective than pharmacological or endoscopic treatment alone for the prevention of rebleeding. Finally, new experimental and clinical studies are needed to improve the pharmacological treatment of
portal hypertension.