Treatment of portal hypertension

Table 2 Primary prophylaxis and secondary prophylaxis of variceal hemorrhage

Therapy	Starting dose	Therapy goals	Maintenance/follow-up
Propranolol	(1) 20 mg orally twice a day; (2) Adjust every 2-3 d until treatment goal is achieved; (3) Maximal daily dose should not exceed 320 mg	(1) Maximum tolerated dose; (2) Aim for resting heart rate of 50-55 beats per minute	(1) At every outpatient visit make sure that patientis appropriately β-blocked; (2) Continue indefinitely; (3) No need for follow-up EGD
Nadolol	(1) 40 mg orally once a day; (2) Adjust every 2-3 d until treatment goal is achieved; (3) Maximal daily dose should not exceed 160 mg	As for propranolol	As for propranolol
EVL	Every 2-4 wk until the obliteration of varices	Obliteration of varices; Eradication of new varices following initial obliteration	First EGD performed 1-3 mo after obliteration and every 6-12 mo thereafter
Propranolol	(1) 20 mg orally twice a day; (2) Adjust every 2-3 d until treatment goal is achieved; (3) Maximal daily dose should not exceed 320 mg	(1) Maximum tolerated dose; (2) Aim for resting heart rate of 50-55 beats per minute	(1) At every outpatient visit make sure that patient is appropriately β-blocked; (2) Continue indefinitely
Nadolol	(1) 40 mg orally once a day; (2) Adjust every 2-3 d until treatment goal is achieved; (3) Maximal daily dose should not exceed 160 mg	As for propranolol	As for propranolol
ISMN	(1) Only to be used in conjunction with propranolol or nadolol; (2) 10 mg orally at night every day; (3) Adjust every 2-3 d by adding 10 mg in am and then pm; (4) Maximal dose is 20 mg twice a day	(1) Maximal tolerated dose; (2) Systolic blood pressure remains over 95 mmHg	Continue indefinitely
EVL	Every 2-4 wk until the obliteration of varices	Obliteration of varices; Eradication of new varices following initial obliteration	First EGD performed 1-3 mo after obliteration and every 6-12 mo thereafter

Either one of the three therapies shown in the table are recommended. EGD: Esophagogastroduodenoscopy; EVL: Endoscopic variceal ligation; ISMN: Isosorbide-5-mononitrate.