The changing role of beta-blocker therapy in patients with cirrhosis.

Background: New data show that arterial pressure is an independent predictor of survival in patients with cirrhosis. Patients with a mean arterial pressure (MAP) >80 have a 1 year survival of 70% compared with only 40% in patients with a MAP <80.

Design:  A recent review in J Hepatology covered the use of beta blockers in the primary and secondary prevention of variceal hemorrhage.

Results: Beta-blockers improve survival only in the middle stages of disease, in a narrow clinical window.

Beta blockers shouldn’t be used in cirrhosis with no significant portal hypertension (no varices), beta blocker does not prevent varix formation, and no increase survival was found from previous studies.

Use beta blockers during the middle stages of cirrhosis when portal hypertension becomes significant and medium to large varices and ascites develop but systemic hemodynamics are still preserved.

Do not beta block in advanced cirrhosis with refractory ascites and hypotension.