Abstract
To date, non-selective beta blockers (NSBBs) are a cornerstone in the treatment of
portal hypertension. During the last years, our understanding of the potential benefits
of early initiation of NSBB treatment, their effects beyond the prevention of variceal
bleeding (i.e., their non-hemodyamic effects), as well as potential detrimental effects
in patients with advanced disease has continuously evolved. In addition, we have learned
that not all NSBBs are equal. Due to its additional anti-α1-adrenergic activity, carvedilol
has been shown to be more potent in decreasing portal pressure, but might lead to
more pronounced decreases in systemic arterial pressure, when compared to conventional
NSBBs. It might be particularly beneficial in ‘early’ portal hypertension, when potential
detrimental effects on systemic hemodynamics are less critical. In contrast, there
is increasing evidence that the use of carvedilol or high NSBB doses should be carefully
scrutinized in patients with severe or refractory ascites.
Our review summarizes the current knowledge on the use of NSBBs for preventing variceal
bleeding and other decompensating events and provides guidance for their safe use
in hemodynamically ‘vulnerable’ patient populations. Finally, we also highlight areas
for further research.
Keywords
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Article info
Publication history
Published online: October 04, 2016
Accepted:
September 19,
2016
Received in revised form:
September 9,
2016
Received:
August 7,
2016
Identification
Copyright
© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
