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Beta‐blockers in portal hypertension: new developments and controversies
Author(s) -
Tripathi Dhiraj,
Hayes Peter C.
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12360
Subject(s) - nadolol , medicine , propranolol , carvedilol , portal hypertension , portal venous pressure , spontaneous bacterial peritonitis , cirrhosis , adrenergic beta antagonists , ascites , adverse effect , esophageal varices , intensive care medicine , cardiology , pharmacology , heart failure
Abstract There are many studies investigating the role of non‐selective beta‐blockers in portal hypertension. Satisfactory reduction in portal pressure is possible in a third to half of patients with propranolol and nadolol, although combining these drugs with nitrates may be more effective. Carvedilol is a more potent agent than propranolol in reducing portal pressure, particularly in non‐responders, and is better tolerated. All these drugs have been studied in primary and secondary prophylaxis, sometimes in combination with band ligation and/or nitrates. There is some evidence to support combining these agents with band ligation, despite a lack of survival benefit and increased adverse events. Hemodynamic monitoring can help select non‐responders who may benefit from additional therapies such as band ligation, as lack of response is associated with worse outcomes. Propranolol should be used with caution in patients with refractory ascites, although the current evidence is not of sufficient quality to justify not using these drugs in such situations. Beta‐blockers have been shown to reduce bacterial translocation and spontaneous bacterial peritonitis in cirrhosis.