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Emerging data show that arterial pressure is an independent predictor of survival in patients with cirrhosis. Patients with a mean arterial pressure (MAP) >80 mmHg have a 1-year survival of 70% compared with only 40% in patients with a MAP ≤80 mmHg. Therefore, drugs that lower the MAP, such as beta-blockers, should be avoided or used with caution (NEJM JW Gastroenterol May 10 2013). The current review covers the use of beta-blockers — commonly used in the primary and secondary prevention of variceal hemorrhage — in patients with cirrhosis.
The authors conclude that beta-blockers improve survival only in a narrow clinical window during the course of cirrhosis. As such, they suggest the following with regard to timing of beta-blocker therapy:
D…