Current status and future goals of the pharmacologic reduction of portal hypertension

The continuous oral administration of different drugs can produce a sustained reduction in portal pressure in patients with portal hypertension. beta-Adrenergic antagonists, alpha 2-adrenergic agonists, and 5-hydroxytryptamine-receptor antagonists have been evaluated for their long-term effects on portal pressure reduction. Clinical studies show that gastrointestinal bleeding can be prevented by pharmacologic therapy. This type of treatment is efficient and safe, and, if a drug has no clinical effect, a different drug or a combination can be used. Several problems, however, need to be addressed, including patient compliance, selection of responders, and hemodynamic evaluation of the treatment and its duration. Although pharmacologic treatment of portal hypertension is known to be efficient, there are advances still to be made.