2. Why?
• Decrease portal pressure
• Decrease risk of bleeding from hypertensive
gastropathy
• Lower incidence of bacterial translocation
• Decrease development of spontaneous
bacterial peritonitis
3. NSBBs achieve their effects through
Reducing cardiac output via Beta 1 receptor
blockade
Reducing portal blood flow through splanchnic
vasoconstriction via Beta 2 receptor blockade
4. Several studies in cirrhotic patients without
NSBB treatment established a correlation
between BP and transplantation-free survival
As cirrhosis progress, cardiovascular system
looses it’s compensatory ability, thus patients
with low mean arterial Bp (< 82 mmHg) had
lower survival
Liach. Gastro 1988
10. Paracentesis induced circulatory
dysfunction (PICD)
Refractory ascites is characterized by repeated
paracentsis, which has been shown to trigger
PICD.
PICD defined as increase in renin level at least
50% one week after paracentesis.
11. Lack of cardiac adaptation after paracentesis
under beta blockers may explain the increase in
PICD incidence.
Patients with PICD who are on NSBB
medications, have a higher incidence of acute
kidney injury (AKI) reaching 71%.
Serste et al., Liver International 2015