Beta-blockers in cirrhosis: evidence-based indications and limitations

Summary Nonselective beta-blockers (NSBBs) are the mainstay of portal hypertension therapy in the setting of liver cirrhosis. RCTs demonstrated their efficacy in preventing first variceal bleeding and rebleeding. Recent evidence indicates that in compensated patients NSBBs could prevent liver decompensation. Despite solid data favouring NSBB use in cirrhosis, some studies have highlighted relevant safety issues in patients with end-stage liver disease, particularly with refractory ascites and infection. This review summarizes the evidence supporting current recommendations and restrictions of NSBB use in patients with cirrhosis.