Non-selective beta-blockers impair global circulatory homeostasis and renal function in cirrhotic patients with refractory ascites.

Background and aims The safety of non-selective -blockers (NSBB) has been questioned in refractory ascites (RA). We studied the effects of NSBB on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive (DRA) and RA. Methods Prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBB for variceal bleeding prophylaxis. The following were measured at baseline and 4-weeks after propranolol: systolic function by the ejection intraventricular pressure difference (EIVPD), hepatic venous pressure gradient (HVPG), cardiopulmonary pressures, RPP, and sympathetic activation. Results EIVPD was elevated at baseline (RA: 4.5 [2.8-5.7] and DRA: 4.2 [3.1-5.7] mmHg; normal: 2.4-3.6 mmHg) and directly related to the severity of vasodilation and sympathetic activation. NSBB led to similar reductions in heart rate and HVPG in both groups. NSBB reduced EIPVD in RA but not in DRA (-20% vs. -2%, p 0.40, all p 0.40, all p Conclusion Renal perfusion and function depend critically of systolic function and sympathetic hyperactivation in RA. NSBB blunt the sympathetic overdrive on cardiac function, hamper cardiac output, lower RPP below the critical threshold and impair renal function.-blockade should be cautious or even avoided in RA