β-Blockers to Prevent Decompensation of Cirrhosis in Compensated Patients With Clinically Significant Portal Hypertension

Abstract

The progression of cirrhosis from the compensated stage to the development of decompensation determines a marked decline in life expectancy. Portal hypertension is the main determinant of the complications defining decompensation (variceal bleeding, ascites, encephalopathy). The development of clinically significant portal hypertension (CSPH, i.e., HVPG ≥10 mmHg) defines a substage of compensated cirrhosis, with a higher risk of decompensation. Non-selective β-blockers (NSBBs) decrease portal pressure in cirrhosis with CSPH. The efficacy of NSBBs to prevent first bleeding in patients with high-risk varices is well established. Recent data suggest that by decreasing portal pressure, NSBBs may also prevent other decompensating events such as ascites and may even improve survival in patients with compensated cirrhosis and CSPH. In this chapter we review the therapeutic potential of NSBBs in patients with compensated cirrhosis and already developed CSPH, indicating a high risk of decompensation.