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Review
. 2019 Dec 20;2(1):100063.
doi: 10.1016/j.jhepr.2019.12.001. eCollection 2020 Feb.

Beta-blockers in cirrhosis: Evidence-based indications and limitations

Susana G Rodrigues  1 , Yuly P Mendoza  1 , Jaime Bosch  1
Affiliations
Review

Beta-blockers in cirrhosis: Evidence-based indications and limitations

Susana G Rodrigues et al. JHEP Rep. .

Abstract

Non-selective beta-blockers (NSBBs) are the mainstay of treatment for portal hypertension in the setting of liver cirrhosis. Randomised controlled trials demonstrated their efficacy in preventing initial variceal bleeding and subsequent rebleeding. Recent evidence indicates that NSBBs could prevent liver decompensation in patients with compensated cirrhosis. Despite solid data favouring NSBB use in cirrhosis, some studies have highlighted relevant safety issues in patients with end-stage liver disease, particularly with refractory ascites and infection. This review summarises the evidence supporting current recommendations and restrictions of NSBB use in patients with cirrhosis.

Keywords: ACLF; ACLF, acute-on-chronic liver failure; AKI, acute kidney injury; ALD, alcohol-related liver disease; ARD, absolute risk difference; AV, atrioventricular; EBL, endoscopic band ligation; GOV, gastroesophageal varices; HRS, hepatorenal syndrome; HVPG, hepatic venous pressure gradient; IGV, isolated gastric varices; IRR, incidence rate ratio; ISMN, isosorbide mononitrate; MAP, mean arterial pressure; NASH, non-alcoholic steatohepatitis; NNH, number needed to harm; NNT, number needed to treat; NR, not reported; NSBBs; NSBBs, non-selective beta-blockers; OR, odds ratio; PH, portal hypertension; PHG, portal hypertensive gastropathy; RCT, randomised controlled trials; RR, risk ratio; SBP, spontaneous bacterial peritonitis; SCL, sclerotherapy; TIPS, transjugular intrahepatic portosystemic shunt; ascites; cirrhosis; portal hypertension; spontaneous bacterial peritonitis; varices.

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Figures

Fig. 1
Fig. 1
Pathophysiology of portal hypertension in cirrhosis and mechanisms and sites of action of non-selective beta-blockers. NSBB, non-selective beta blocker.
Fig. 2
Fig. 2
Levels of evidence for non-selective beta-blockers in cirrhosis according to indication. CSPH, clinically significant portal hypertension; GOV1-2, gastroesophageal varices type 1/2; IGV1, isolated gastric varices type 1; NSBB, non-selective beta blocker; RCT, randomised controlled trial.
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