Systemic arterial blood pressure determines the therapeutic window of non-selective beta blockers in decompensated cirrhosis.
Aliment Pharmacol Ther
; 50(6): 696-706, 2019 09.
Article
en En
| MEDLINE
| ID: mdl-31373713
ABSTRACT
BACKGROUND:
The safety of non-selective ß-blockers in patients with advanced cirrhosis has been questioned in recent years. It was hypothesised that there is a particular therapeutic window. However, the specific limits still need to be determined.AIM:
To evaluate potential limits of the therapeutic window of non-selective ß-blocker therapy in patients with cirrhosis and ascitesMETHODS:
The impact of non-selective ß-blockers on 28-day transplant-free survival was analysed in a cohort of 624 consecutive patients with decompensated cirrhosis and ascites. Three potential limits were investigated spontaneous bacterial peritonitis, acute-on-chronic liver failure, mean arterial blood pressure ≤ 82 and < 65 mm Hg.RESULTS:
Treatment with non-selective ß-blockers was associated with a higher 28-day transplant-free survival in the overall cohort (hazard ratio 0.621; P = .035) as well as in patients with acute-on-chronic liver failure (hazard ratio 0.578; P = .031) and those with spontaneous bacterial peritonitis (hazard ratio 0.594; P = .073). In contrast, survival benefits were markedly attenuated in patients with a mean arterial blood pressure ≤ 82 mm Hg and completely lost in those with mean arterial blood pressure < 65 mm Hg (P = .536). In spontaneous bacterial peritonitis patients with a mean arterial blood pressure < 65 mm Hg non-selective ß-blocker treatment was associated with renal impairment. Of note, among those with a mean arterial blood pressure ≥ 65 mm Hg non-selective ß-blocker intake was consistently associated with superior transplant-free survival (hazard ratio 0.582; P = .029) irrespective of the presence of spontaneous bacterial peritonitis (hazard ratio 0.435; P = .028) or acute-on-chronic liver failure (hazard ratio 0.480 P = .034).CONCLUSIONS:
Ascites, acute-on-chronic liver failure and spontaneous bacterial peritonitis do not limit the safe use of non-selective ß-blockers in patients with cirrhosis. Mean arterial blood pressure might represent a better indicator to determine the therapeutic window of non-selective ß-blocker treatment.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Antagonistas Adrenérgicos beta
/
Presión Arterial
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Cirrosis Hepática
Límite:
Adult
/
Aged
/
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Aliment Pharmacol Ther
Asunto de la revista:
FARMACOLOGIA
/
GASTROENTEROLOGIA
/
TERAPIA POR MEDICAMENTOS
Año:
2019
Tipo del documento:
Article
País de afiliación:
Alemania