Portal hypertension is defined as a hepatic venous pressure gradient (HVPG) above which threshold, and clinical complications (variceal bleeding) typically begin at which HVPG level?

• A HVPG >5 mmHg defines portal hypertension; clinically significant portal hypertension (variceal risk) begins at HVPG >10–12 mmHg ✓
• B HVPG >10 mmHg defines portal hypertension; variceal bleeding occurs at HVPG >15 mmHg
• C HVPG >8 mmHg defines portal hypertension; varices form at HVPG >20 mmHg
• D HVPG >12 mmHg is the universal threshold for both portal hypertension and variceal risk

Explanation

Normal HVPG is 1–5 mmHg. Portal hypertension is defined as HVPG >5 mmHg. Clinically significant portal hypertension, associated with development of varices and risk of variceal haemorrhage, begins at HVPG ≥10–12 mmHg. Variceal haemorrhage virtually does not occur below an HVPG of 12 mmHg, making 12 mmHg the threshold above which bleeding risk exists. Treatment targets in secondary prophylaxis aim to reduce HVPG below 12 mmHg or by ≥20% from baseline.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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