Medikamentöse Therapie der portalen Hypertension

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.

Kernaussagen

• In westlichen Industrienationen ist die Leberzirrhose die häufigste Ursache der portalen Hypertension.

• Ein HVPG >10mmHg definiert das Vorliegen einer klinisch signifikanten portalen Hypertension.

• Eine CPSH kann invasiv durch eine Messung des HVPG oder nicht invasiv durch eine Bestimmung der Lebersteifigkeit, Thrombozytenzahl und Milzsteifigkeit bestimmt werden.

• Nicht selektive Betablocker (NSBB) stellen die medikamentöse Standardtherapie der portalen Hypertension bei Vorliegen einer CSPH dar.

• Carvedilol führt aufgrund der zusätzlich α1-antiadrenergen Effekte im Vergleich zu traditionellen NSBB (z.B. Propanolol) zu einer höheren Senkung des portalen Drucks.

• Bei Patienten mit einer kompensierten Leberzirrhose reduziert Carvedilol besser als traditionelle NSBB das Risiko einer Varizenblutung sowie das Auftreten einer hepatischen Dekompensation.

Schlüsselwörter

Leberzirrhose - Dekompensation - Portale Hypertension - Carvedilol - Nicht-selektive Beta-Blocker

Keywords

liver cirrhosis - hepatic decompensation - portal hypertension - Carvedilol - non-selective beta-blockers

Publication History

Received: 15 October 2023

Accepted after revision: 18 December 2023

Article published online:
13 March 2024

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