This study investigated the correlation between changes in hepatic hemodynamics and esophageal variceal pressure–measured with a noninvasive, pressure-sensitive endoscopic gauge–in 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 ± 1 to 17.3 ± 1 mm Hg, p < 0.001), azygos blood flow (from 0.61 ± 0.06 to 0.39 ± 0.03 L/min, p < 0.001) and variceal pressure (from 13.1 ± 0.9 to 10.2 ± 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 ± 1.6%). However, we found no significant differences between propranolol responders and nonresponders with regard to the decrease in variceal pressure (3.3 ± 0.7 vs. 2.3 ± 1.4 mm Hg) and azygos blood flow (0.23 ± 0.07 vs. 0.21 ± 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 with a significant decrease in variceal pressure and azygos blood flow. These favorable effects are also observed in some patients in whom hepatic venous pressure gradient fails to decrease by more than 10% of the baseline value, suggesting that propranolol administration has beneficial effects in some of these patients. (HEPATOLOGY 1993;18:1082-1089).