This study investigated the correlation between changes in hepatic hemodynamics and esophageal variceal pressuremeasured with a noninvasive, pressure-sensitive endoscopic gaugein 37 portal-hypertensive cirrhotic patients receiving propranolol (0.15 mg/kg, intravenously; n = 21) or placebo (n = 16) under strict double-blind conditions. Placebo administration had no effect on hepatic venous pressure gradient, azygos blood flow or variceal pressure. Propranolol caused a significant reduction in hepatic venous pressure gradient (from 19.6 f 1 to 17.3 f 1 mm Hg, p < 0.001), azygos blood flow (from 0.61 f 0.06 to 0.39 2 0.03 L/min, p < 0.001) and variceal pressure (from 13.1 -t 0.9 to 10.2 f 0.9 mm Hg, p < 0.001). In eight patients (propranolol nonresponders) hepatic venous pressure gradient was not modified or decreased by less than 10% after propranolol (mean change, -4.1 f 1.6%). However, we found no significant differences between propranolol responders and nonresponders with regard to the decrease in variceal pressure (3.3 2 0.7 vs. 2.3 2 1.4 mm Hg) and azygos blood flow (0.23 r 0.07 vs. 0.21 f 0.07 L/min). As expected, in most propranolol responders (11 of 13), reduction in hepatic venous pressure gradient was accompanied by a similar response in variceal pressure ( > 10% decrease). However, among propranolol nonresponders, in terms of reduction in hepatic venous pressure gradient, four out of eight patients had decreases greater than 10% in variceal pressure. The results of this study confirm that reduction in hepatic venous pressure gradient by propranolol is associated