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Beta-blockers may prevent decompensated cirrhosis for portal hypertension

New data published in Hepatology showed that beta-blockers lowered portal pressure in patients with clinically significant portal hypertension, suggesting they could prevent decompensation of cirrhosis in this patient population.

“This study was aimed at characterizing the splanchnic and systemic hemodynamic profile of the different evolutionary stages of [portal hypertension] in compensated cirrhosis, with and without [clinically significant portal hypertension], and the hemodynamic response to [beta]-blockers in each of these stages,” the researchers wrote.

Hepatic venous pressure gradient (HVPG) and systemic hemodynamic measurements were performed in 273 patients with compensated cirrhosis, of which 194 patients had clinically significant portal hypertension (CSPH, HVPG > 10 mm Hg) with either no varices (n = 80) or small varices (n = 114). Seventy-nine patients had subclinical portal hypertension (HVPG > 5 and < 10 mm Hg).

The patients with CSPH tended to have higher liver stiffness (P < .001), worse MELD score (P < .001), more portosystemic collaterals (P = .01), and splenomegaly (P = .01) on ultrasound, and lower platelet count (P < .001) compared with patients with subclinical portal hypertension.

In addition, patients with CSPH had lower systemic vascular resistance (P < .05) and higher cardiac index (P < .01) compared with subclinical patients.

After beta-blocker propranolol was administered, HVPG decreased significantly in both groups. However, the patients with CSPH experienced a greater reduction (– 16 ± 12% vs. – 8 ± 9%; P < .01). HVPG levels decreased more than 10% from baseline in 69% of patients with CSPH compared with 35% for those with subclinical portal hypertension (P < .001). HVPG also decreased more than 20% from baseline in 40% of patients with CSPH compared with 13% of patients with subclinical portal hypertension (P = .001).

“The present study shows that patients with early compensated cirrhosis have different systemic hemodynamic patterns according to the presence or absence of CSPH,” the researchers wrote.

Multivariate analysis showed CSPH to be an independent predictor of HVPG response to beta-blockers (OR = 5.1; 95% CI, 2.3-10.1) after adjusting for MELD score, presence of varices, baseline HVPG, heart rate and etiology of cirrhosis.

“Our study shows that [beta]-blockers induce a markedly greater portal-pressure lowering effect in patients with CSPH than in those with subclinical [portal hypertension],” the researchers concluded. “These findings suggest that [beta]-blockers may be suitable to prevent decompensation of cirrhosis with CSPH, but that their potential benefit on the progression of [portal hypertension] may be lower at earlier stages of cirrhosis.” – by Melinda Stevens

Disclosure: Villanueva reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.