Document Detail

Beta blockers in portal hypertension. Are they really a good option?
MedLine Citation:
PMID:  16807514     Owner:  NLM     Status:  MEDLINE    
Non-selective beta blockers are very useful drugs in preventing first variceal bleeding and re-bleeding in patients with cirrhosis. These drugs work in two ways: 1) by blocking beta1 receptors and reducing cardiac output, and 2) by blocking beta2 receptors, producing splanchnic vasoconstriction and reducing portal flow. Consequently, they reduce portal pressure. In primary prophylaxis, beta blockers reduced the bleeding risk from 30 to 15%; in secondary prophylaxis, this risk decreased from 60 to 42% in the first year. Heart rate decrease does not necessary correlate with reduction in hepatic venous pressure gradient (HVPG). When this gradient is reduced to less than 12 mmHg, the patient will not bleed; when this is reduced > 20% from basal values bleeding risk is extremely low, estimated at 9% at 2 years. The only way to know whether the patient has become a responder is to measure the HVPG. Additionally, by means of this method we also can identify the non-responders, who have a higher rate of re-bleeding, between 54 and 64%, and can attempt to utilize a more aggressive therapy, such as adding isosorbide mononitrate to the beta blocker or combining the beta blocker with endoscopic ligation. These options are discussed in the present review.
Eric López-Méndez; Misael Uribe
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of hepatology     Volume:  5     ISSN:  1665-2681     ISO Abbreviation:  Ann Hepatol     Publication Date:    2006 Apr-Jun
Date Detail:
Created Date:  2006-06-29     Completed Date:  2006-11-02     Revised Date:  2013-05-16    
Medline Journal Info:
Nlm Unique ID:  101155885     Medline TA:  Ann Hepatol     Country:  Mexico    
Other Details:
Languages:  eng     Pagination:  86-91     Citation Subset:  IM    
Gastroenterology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Hemorrhage / prevention & control*
Hypertension, Portal / drug therapy*
Reg. No./Substance:
0/Adrenergic beta-Antagonists

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