Diagnosis of Portal Hypertension

Chronic liver disease (CLD) imposes a major global health burden, with portal hypertension (PH) and its complications driven by complex pathophysiological mechanisms. Understanding these processes is essential for effective therapy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessing portal hypertension, providing key diagnostic, prognostic, and therapeutic guidance-particularly in distinguishing its type and monitoring response to treatments such as non-selective beta-blockers. While non-invasive tests like elastography and serum biomarkers are valuable for screening and follow-up, they cannot fully replace HVPG when precise measurement is needed. HVPG contains not only prognostic information but also helps to decide if pharmacological therapy is indicated and to monitor therapeutic effects with reductions correlating with improved outcomes. In this review, we highlight the comprehensive management of patients with PH and the indications for measurement of HVPG.