Beta adrenergic blockade and decompensated cirrhosis

J Hepatol. 2017 Apr;66(4):849-859. doi: 10.1016/j.jhep.2016.11.001. Epub 2016 Nov 15.


Non-selective betablockers (NSBBs) remain the cornerstone of medical treatment of portal hypertension. The evidence for their efficacy to prevent variceal bleeding is derived from prospective trials, which largely excluded patients with refractory ascites and renal failure. In parallel to the increasing knowledge on portal hypertension-induced changes in systemic hemodynamics, cardiac function, and renal perfusion, emerging studies have raised concerns about harmful effects of NSBBs. Clinicians are facing an ongoing controversy on the use of NSBBs in patients with advanced cirrhosis. On the one hand, NSBBs are effective in preventing variceal bleeding and might also have beneficial non-hemodynamic effects, however, they also potentially induce hypotension and limit the cardiac reserve. An individualized NSBB regimen tailored to the specific pathophysiological stage of cirrhosis might optimize patient management at this point. This article aims to give practical recommendations on the use of NSBBs in patients with decompensated cirrhosis.

Keywords: Ascites; Beta blockers; Decompensation; Esophageal and gastric varices; Gastrointestinal hemorrhage; Hypertension, portal; Liver cirrhosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / adverse effects*
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Ascites / drug therapy
  • Ascites / physiopathology
  • Esophageal and Gastric Varices / drug therapy
  • Esophageal and Gastric Varices / physiopathology
  • Female
  • Humans
  • Hypertension, Portal / drug therapy
  • Hypertension, Portal / physiopathology
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / physiopathology
  • Male
  • Prognosis


  • Adrenergic beta-Antagonists