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Beta-blockers reduce risk of ascites in cirrhotic patients

Beta-blockers can reduce development of ascites and other complications of compensated cirrhosis, according to recent study results.

A study to determine the effects of beta-blockers on portal hypertension and ascitic decompensation evaluated 83 patients with compensated cirrhosis and large esophageal varices. Researchers established baseline hemodynamic measurements before administering nadolol once daily at a starting dose of 40 mg, then repeated the hemodynamic study 1 to 3 months later, with 53±30 months of follow-up. The participants had not previously experienced decompensation, and had hepatic venous pressure gradients at or greater than 12 mm Hg.

Decompensation was observed in 52 patients (62%), with ascites as its first manifestation in 81% of those participants. Patients with a hepatic venous pressure gradient decrease of more than 10% after treatment were less likely to develop ascites (19% vs. 57% after 3 years; P,.001) than nonresponders. Ascites development was independently associated with nonresponse to treatment (P,.001). Responsive patients also were less likely to develop refractory ascites (P=.007), hepatorenal syndrome (P=.027) and spontaneous bacterial peritonitis (7% vs. 2% after two years; P=.4).

“The results of this study indicate that, in patients with compensated cirrhosis and severe [portal hypertension] with large varices, achieving an [hepatic venous pressure gradient] decrease [greater than] 10% from baseline with beta-blockers provides a significant reduction on the risk of first ascitic decompensation,” researchers wrote. “Whether treatment of [portal hypertension], with beta-blockers or other drugs, can prevent the development of ascites … should be confirmed in a future randomized control trial.”