title: Beta blockers and cirrhosis, 2016.
abstract: To date, non-selective beta blockers (NSBBs) are a cornerstone in the treatment of portal hypertension. During the last years, our understanding of the potential benefits of early initiation of NSBB treatment, their effects beyond the prevention of variceal bleeding (i.e., their non-hemodyamic effects), as well as potential detrimental effects in patients with advanced disease has continuously evolved. In addition, we have learned that not all NSBBs are equal. Due to its additional anti-α1-adrenergic activity, carvedilol has been shown to be more potent in decreasing portal pressure, but might lead to more pronounced decreases in systemic arterial pressure, when compared to conventional NSBBs. It might be particularly beneficial in 'early' portal hypertension, when potential detrimental effects on systemic hemodynamics are less critical. In contrast, there is increasing evidence that the use of carvedilol or high NSBB doses should be carefully scrutinized in patients with severe or refractory ascites. Our review summarizes the current knowledge on the use of NSBBs for preventing variceal bleeding and other decompensating events and provides guidance for their safe use in hemodynamically 'vulnerable' patient populations. Finally, we also highlight areas for further research.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Austria. Electronic address: mattias.mandorfer@meduniwien.ac.at.
authors.forename: Mattias
authors.initials: M
authors.lastname: Mandorfer
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reiberger
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001201:Ascites / Q000517:prevention & control; D002227:Carbazoles / Q000009:adverse effects / Q000627:therapeutic use*; D000077261:Carvedilol; D004932:Esophageal and Gastric Varices / Q000503:physiopathology; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006439:Hemodynamics; D006530:Hepatorenal Syndrome / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000188:drug therapy*; D008103:Liver Cirrhosis / Q000503:physiopathology; D017082:Portal Pressure; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol
keywords: Ascites; Hepatic venous pressure gradient; Hepatorenal syndrome; Portal hypertension; Variceal bleeding; Varices