Pharmacological control of portal hypertension

The initiation and maintenance of portal hypertension, development of portosystemic shunts, including esophagogastric varices, and precipitation of variceal hemorrhage result from a number of different although related hemodynamic variables. Knowledge of these pathophysiological mechanisms is essential for an understanding of the pharmacological therapy of portal hypertension. Conversely, pharmacological studies continue to provide new insights and expand our understanding of these pathophysiological mechanisms. Future pharmacological studies should contribute to our understanding of the role of endothelial-dependent and -independent mechanisms in the regulation of vascular tone in chronic liver disease, the regulation of intrahepatic resistance, and the development and modulation of the portocollateral vascular bed. Ideally, this will yield increasingly effective pharmacological therapies for the management of portal hypertension.