HVPG values >5 mmHg indicate sinusoidal portal hypertension.

In patients with viral- and alcohol-related cirrhosis, HVPG measurement is the gold-standard method to determine the presence of “clinically significant portal hypertension” (CSPH), which is defined as an HVPG ≥10 mmHg.

In patients with primary biliary cholangitis, there may be an additional pre-sinusoidal component of portal hypertension that cannot be assessed by HVPG. As such, in these patients, HVPG may underestimate the prevalence and severity of PH.

In patients with non-alcoholic steatohepatitis (NASH)-related cirrhosis, although an HVPG ≥10 mmHg remains strongly associated with the presence of clinical signs of portal hypertension, these signs can also be present in a small proportion of patients with HVPG values <10 mmHg.

In patients with chronic liver disease and clinical signs of portal hypertension (gastro-oesophageal varices, ascites, portosystemic collateral vessels) but with HVPG <10 mmHg, porto-sinusoidal vascular disorder (PSVD) must be ruled out.

In alcohol-related or viral cirrhosis, a decrease in HVPG in response to non-selective beta-blockers (NSBBs) is associated with a significant reduction in the risk of variceal bleeding or of other decompensating events.

References:

Corrigendum to ‘Baveno VII – Renewing consensus in portal hypertension’ [J Hepatol (2022) 959-974] Journal of Hepatology, Vol. 77, Issue 2