Preliminary assessments of chronic obstructive pulmonary disease, asthma, severe bradycardia, and atrioventricular blocks were performed to rule out contraindication to NSBB use.
Those patients having a new indication to start NSBB for primary prophylaxis of variceal bleeding (e.g., patients with small varices with red wale marks or Child-Pugh C class; patients with medium-large varices) were enrolled.
Central and peripheral hemodynamics were analyzed before and after two LVP, while being on and off NSBB therapy.
During the study period, thirty-five patients with RA were prospectively evaluated, of whom 18 (51.4%) were not included for the following reasons: ongoing chronic antihypertensive therapies or contraindication to NSBB introduction (n = 8), hepatocellular carcinoma (n = 3), criteria for refractory ascites not fulfilled (n = 3), noncirrhotic portal hypertension (n = 2), and nonadherence (n = 2).
NSBBs are associated with poor survival in patients with refractory ascites and thus are contraindicated in these patients.
Endoscopic variceal ligation is an alternative to NSBBs for the primary prophylaxis of variceal hemorrhage in patients with medium to large varices.
Non-selective beta-blockers (NSBBs) decrease the hepatic venous pressure gradient (HPVG) by about 15% through blockade of beta-1 receptors (reduction in cardiac output) and beta-2 receptors (alpha-adrenergic vasoconstriction) (Minano & Garcia-Tsao, 2010; Turis, 2010).
Also, because NSBBs increase bowel motility and reduce bacterial overgrowth, they decrease variceal bleeding triggers such as infection (Villanueva & Balanzo, 2008).
The NSBBs most commonly prescribed for primary prevention of variceal bleeding are propranolol hydrochloride (Inderal[R]) and nadolol (Corgard[R]).
Study inclusion criteria were age 18-80 and presence of liver cirrhosis and PHT where commencement of NSBB was clinically indicated.
Starting doses of once-daily NSBB were 6.25 mg for carvedilol and 80 mg for modified release propranolol.
19 out of 22 participants had both baseline and repeat MRI scans (1 patient died from complications of cirrhosis during the study; 2 patients were unable to tolerate NSBB, both on propranolol).