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Clinically significant portal hypertension (CSPH; portal pressure ≥10 mmHg) is a key driver of hepatic decompensation (development of ascites, encephalopathy, or variceal hemorrhage) in patients with compensated cirrhosis. To determine whether reducing portal pressure in this high-risk group using beta-blocker therapy lowers decompensation and death rates, investigators in Spain conducted a randomized, controlled trial in 201 patients with compensated cirrhosis and CSPH.
Participants were divided into a beta-blocker–responsive group (135 patients; defined as those who had a ≥10% drop in hepatic venous pressure gradient from baseline when given a propranolol infusion challenge) and a beta-blocker–nonresponsive group (66 patients). The respons…