- •Non-selective beta-blockers (NSBB) are the backbone for the treatment of portal hypertension in patients with liver cirrhosis.
- •Relevant side effects of NSBB may occur in patients with more impaired liver function.
- •NSBB use seems to be associated with the presence of covert hepatic encephalopathy.
- •NSBB use seems to increase the incidence of overt hepatic encephalopathy in patients with decompensated cirrhosis.
Abbreviations:HE (hepatic encephalopathy), MHE (minimal hepatic encephalopathy), CHE (covert hepatic encephalopathy), HVPG (hepatic venous pressure gradient), HE1 (hepatic encephalopathy grade 1), PHES (Portosystemic Hepatic Encephalopathy Score), MELD (model of end stage liver disease), NAFLD (non-alcoholic fatty liver disease), NSBB (non-selective β-blocker(s))
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Internal Medicine
- Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis.BMC Med. 2014; 12: 145https://doi.org/10.1186/s12916-014-0145-y
- Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the study of liver diseases and the European Association for the study of the liver.Hepatology. 2014; 60: 715-735https://doi.org/10.1002/hep.27210
- [Therapy of acute and chronic hepatic encephalopathy in patients with liver cirrhosis].Z Gastroenterol. 1998; 36: 909-916
- Persistence of cognitive impairment after resolution of overt hepatic encephalopathy.Gastroenterology. 2010; 138: 2332-2340https://doi.org/10.1053/j.gastro.2010.02.015
- Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients.Aliment Pharmacol Ther. 2018; 48: 313-321https://doi.org/10.1111/apt.14824
- Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study.Hepatology. 2010; 51: 1675-1682https://doi.org/10.1002/hep.23500
- Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis.World J Hepatol. 2014; 6: 363-369https://doi.org/10.4254/wjh.v6.i6.363
- Beta-blockers in liver cirrhosis.Ann Gastroenterol. 2014; 27: 20-26
- beta blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial.Lancet. 2019; 393: 1597-1608https://doi.org/10.1016/S0140-6736(18)31875-0
- Nonselective beta-blockers do not affect mortality in cirrhosis patients with ascites: Post Hoc analysis of three randomized controlled trials with 1198 patients.Hepatology. 2016; 63: 1968-1976https://doi.org/10.1002/hep.28352
- Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis.Gastroenterology. 2014; 146 (e1681): 1680-1690https://doi.org/10.1053/j.gastro.2014.03.005
- A risk score to predict the development of hepatic encephalopathy in a population-based cohort of patients with cirrhosis.Hepatology. 2018; 68: 1498-1507https://doi.org/10.1002/hep.29628
- Development and validation of a prognostic score to predict covert hepatic encephalopathy in patients with cirrhosis.Am. J. Gastroenterol. 2019; 114: 764-770https://doi.org/10.14309/ajg.0000000000000121
- Neuropsychological characterization of hepatic encephalopathy.J Hepatol. 2001; 34: 768-773
- Targets to improve quality of care for patients with hepatic encephalopathy: data from a multi-centre cohort.Aliment Pharmacol Ther. 2019; 49: 1518-1527https://doi.org/10.1111/apt.15265
- Testing for minimal hepatic encephalopathy in the United States: an AASLD survey.Hepatology. 2007; 45: 833-834https://doi.org/10.1002/hep.21515
- Epidemiology of hepatic encephalopathy in german hospitals - the EpHE study.Z Gastroenterol. 2017; 55: 741-747https://doi.org/10.1055/s-0043-114671
- Minimal hepatic encephalopathy is associated with falls.Am J Gastroenterol. 2011; 106: 476-482https://doi.org/10.1038/ajg.2010.413
- Hepatic encephalopathy and fitness to drive.Gastroenterology. 2009; 137 (e1701-1709): 1706-1715https://doi.org/10.1053/j.gastro.2009.08.003
- Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis.Gastroenterology. 2015; 149: 1483-1489https://doi.org/10.1053/j.gastro.2015.07.067
- Propranolol increases arterial ammonia in liver cirrhosis.Lancet. 1982; 2: 951-952https://doi.org/10.1016/s0140-6736(82)90158-1
- Effects of acute cardioselective and non-selective beta-adrenergic blockade on plasma ammonia levels in exercising dogs.Arch Physiol Biochem. 1996; 104: 14-19https://doi.org/10.1076/apab.126.96.36.19972
- The effect of propranolol on the rise in plasma ammonia during modest exercise.Eur J Clin Pharmacol. 1987; 32: 149-151
- Drug-induced cognitive impairment: effect of cardiovascular agents.Ment Health Clin. 2016; 6: 201-206https://doi.org/10.9740/mhc.2016.07.201
- Impairment of memory function by antihypertensive medication.Arch Gen Psychiatry. 1983; 40: 1109-1112https://doi.org/10.1001/archpsyc.1983.01790090071011
- Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis.N Engl J Med. 2005; 353: 2254-2261https://doi.org/10.1056/NEJMoa044456
- Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol.Gut. 2013; 62: 1634-1641https://doi.org/10.1136/gutjnl-2012-304038
- Systemic arterial blood pressure determines the therapeutic window of non-selective beta blockers in decompensated cirrhosis.Aliment Pharmacol Ther. 2019; 50: 696-706https://doi.org/10.1111/apt.15439
- Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy.Metab Brain Dis. 2016; 31: 267-272https://doi.org/10.1007/s11011-015-9741-6