Non-Selective Beta-Blockers in Patients with Cirrhosis: Current Evidence and Controversy

Abstract

Non-selective beta-blockers (NSBBs) are the cornerstone of management of liver cirrhosis and its complications. They decrease portal vein blood flow and portal vein pressure via antagonism of β1 and β2 receptors, thereby improving the hyperdynamic circulatory status and reducing the risk of decompensated events in cirrhotic patients with portal hypertension (PH). Currently, NSBBs have been recommended for the primary and secondary prevention of variceal bleeding in patients with cirrhosis. Nevertheless, it has been noted that the clinical risk-benefit ratio appears to deteriorate for NSBBs in patients with advanced liver cirrhosis. Considering that the use of NSBBs in the clinical practice of cirrhotic patients remains controversial, this chapter aims to summarize the evidence of current recommendations and controversies regarding the use of NSBBs in patients with cirrhosis.