Which of the following symptoms is associated with significant complications of Portal Hypertension?

Esophageal hemorrhage is associated with significant complications of portal hypertension due to the increased pressure in the portal vein, which can lead to the formation of varices—dilated veins that are prone to rupture. The esophagus is a common site for these varices, and when they rupture, they can cause life-threatening bleeding. This complication is a direct consequence of the elevated pressure in the portal system and is a critical concern in patients suffering from portal hypertension.

In the context of the other symptoms, while each can be serious in their own right, they do not have the same direct and severe association with portal hypertension's complications. Hematuria, which refers to blood in urine, usually relates more to urinary tract conditions rather than portal pressures. Chest pain can arise from numerous cardiovascular or respiratory issues and isn't specifically linked to portal hypertension. Hypotension, on the other hand, could be a systemic response to significant bleeding or sepsis, but it’s not a direct complication of portal hypertension itself. The significant risk of life-threatening bleeding from esophageal varices makes esophageal hemorrhage the most pertinent complication related to portal hypertension.