Portal hypertension (PH) is the primary driver of decompensation in patients with cirrhosis and the main pathogenic mechanism in those with variceal hemorrhage. Reducing portal pressure (PP) is key in the management of patients with compensated cirrhosis and in those with variceal hemorrhage. Therapeutic strategies to reduce portal pressure vary by clinical setting, with distinct goals depending on the clinical scenario. Non-selective beta-blockers (NSBB) are used in compensated patients to prevent decompensation, and in decompensated patients with ascites and at-risk varices, to prevent variceal hemorrhage. Systemic vasoconstrictors and endoscopic variceal ligation (EVL) are used in patients with acute variceal hemorrhage (VH) to achieve hemostasis. EVL is also used in combination with NSBB to prevent recurrent VH after patients recover from acute VH, or to prevent an initial episode of VH in patients without prior bleeding that do not tolerate NSBB. Finally, the transjugular intrahepatic portosystemic shunt (TIPS) is used preemptively in select patients with VH that has been recently controlled as well as in the prevention of recurrent variceal hemorrhage and in the management of refractory ascites.