title: Beta adrenergic blockade and decompensated cirrhosis.
abstract: 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.
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Electronic address: thomas.reiberger@meduniwien.ac.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reiberger
authors.affiliation: Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.
authors.forename: Mattias
authors.initials: M
authors.lastname: Mandorfer
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D001201:Ascites / Q000188:drug therapy / Q000503:physiopathology; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011379:Prognosis
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Ascites; Beta blockers; Decompensation; Esophageal and gastric varices; Gastrointestinal hemorrhage; Hypertension, portal; Liver cirrhosis