Abstract
In western industrialized nations, liver cirrhosis is the most common cause of portal
hypertension. Portal hypertension is defined by a persistent increase in portal pressure
>7mmHg. An HVPG >10mmHg defines the presence of clinically significant portal hypertension.
The presence of clinically significant portal hypertension (CSPH) in patients with
liver cirrhosis is a key risk factor for the transition from a compensated to a decompensated
stage of the disease. CPSH can be determined invasively by measuring HPVG or noninvasively
by measuring liver stiffness, platelet count and spleen stiffness. If acute decompensation
manifests itself (e.g. ascites, esophageal variceal bleeding), this is associated
with a significant increase in patient morbidity and mortality. Non-selective beta
blockers (NSBB) are the standard medical therapy for portal hypertension in the presence
of CSPH. Due to the additional α1-antiadrenergic effects, carvedilol leads to a greater
reduction in portal pressure compared to traditional NSBB (e.g. Propanolol). In patients
with compensated liver cirrhosis, carvedilol is better than traditional NSBB at reducing
the risk of variceal bleeding and the occurrence of hepatic decompensation. The early
identification of CSPH and evaluation of drug therapy to reduce portal hypertension
is therefore crucial to improve the prognosis of patients.
Das Vorliegen einer klinisch signifikanten portalen Hypertension (CSPH) bei Patienten
mit Leberzirrhose ist ein Risikofaktor für den Übergang eines kompensierten in ein
dekompensiertes Krankheitsstadium. Manifestiert sich eine akute Dekompensation, ist
dies mit einer deutlichen Zunahme der Morbidität und Mortalität verbunden. Die frühzeitige
Identifikation einer CSPH und Evaluation einer medikamentösen Therapie zur Senkung
der portalen Hypertension ist entscheidend für die Prognose.
Schlüsselwörter
Leberzirrhose - Dekompensation - Portale Hypertension - Carvedilol - Nicht-selektive
Beta-Blocker
Keywords
liver cirrhosis - hepatic decompensation - portal hypertension - Carvedilol - non-selective
beta-blockers