Beta-adrenergic blockers often beta adrenoreceptors are medications that reduce blood pressure by blocking the effects of the hormone epinephrine, also known as adrenaline, which blocks beta-adrenergic receptors, and slows or blocks cell activity.

Non-selective beta-blockers are the mainstay of treatment in liver cirrhosis induced portal hypertension and are well-established in controlling variceal bleed in patients with cirrhosis, the use of non-selective beta blockers therapy in the secondary prevention of variceal bleed was first introduced in 1981.

We at South Asian Liver Institute do not use Beta blockers in patients who do not have varices, because using beta blockers in these patients doesn’t prevent the formation of varices. The risk-benefit in this stage weighs more to risk of adverse effects by the use of beta blockers.9
As a result, non-selective beta-blockers in patients with a medium to large varices reduces the risk hemorrhage by over 50%.

At South Asian liver institute, we recommended that beta blockers to be discontinued in patients with cirrhosis if systolic blood pressure < 90mmHg, mean arterial pressure ≤ 82mmHg, serum sodium level <120meq/l, acute kidney injury, hepatorenal syndrome, spontaneous bacterial peritonitis, sepsis, severe alcoholic hepatitis, poor follow-up and nonadherence to beta-blockers therapy.

Beta-blockers should be cautiously used in patients with refractory ascites, when we prescribe beta-blockers at South Asian Liver Institute, we will taper the doses carefully and discontinued when patients develop signs of decreased organ perfusion or significant hypotension, decreased renal perfusion, and increased risk of hepatorenal syndrome and mortality.

Conclusion

Non-selective beta-blockers are the mainstay of treatment in liver cirrhosis induced portal hypertension with a medium to large varices, it reduces portal blood flow and hence lead to a reduction of portal hypertension which then lowers variceal bleed by over 50%. Patients who do not have varices, using beta blockers in these patients doesn’t prevent the formation of varices. The risk-benefit in this stage weighs more to risk of adverse effects by the use of beta blockers. Beta blockers to be discontinued in patients with cirrhosis if systolic blood pressure < 90mmHg, mean arterial pressure ≤ 82mmHg, serum sodium level <120meq/l, acute kidney injury, hepatorenal syndrome, spontaneous bacterial peritonitis, sepsis, severe alcoholic hepatitis.