The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study

Seong Hee Kang, Minjong Lee, Moon Young Kim, Jun Hyeok Lee, Baek Gyu Jun, Tae Suk Kim, Dae Hee Choi, Ki Tae Suk, Young Don Kim, Gab Jin Cheon, Dong Joon Kim, Soon Koo Baik

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aim: We investigated the effect of non-selective β-blockers (NSBB) in real-world situations and whether low-dose NSBB is beneficial compared to maximally tolerated doses. Methods: We performed a retrospective study of 740 patients with cirrhosis requiring prophylactic treatment of esophageal varices: 473 primary prophylaxis (PP: NSBB = 349, non-NSBB = 124) and 267 secondary prophylaxis (SP: NSBB = 200, non-NSBB = 67). The NSBB group was divided into low-dose (≤ 80 mg/day) and high-dose (> 80 mg/day). Results: In the PP group, NSBB treatment reduced mortality and showed the most pronounced effect in patients with moderate/severe ascites (hazard ratio [HR], 0.46; p < 0.01), HVPG ≥ 16 mmHg (HR, 0.53; p = 0.04), or CTP class B/C (HR, 0.46; p < 0.01) but not in those with no/mild ascites, HVPG < 16 mmHg, or CTP class A. Low-dose NSBB group showed a significant reduction in mortality compared with non-NSBB (moderate/severe ascites: HR, 0.61; p = 0.02 and CTP class B/C: HR, 0.41; p < 0.01) and the effect size was stronger than the high-dose NSBB. NSBB was associated with a reduced risk of infection (HR, 0.36; p = 0.01). In the SP group, NSBB prolonged survival in patients with moderate/severe ascites (HR, 0.56; p = 0.02), HVPG ≥ 16 mmHg (HR, 0.42; p < 0.01), or CTP class B/C (HR, 0.52; p < 0.01). Low-dose NSBB was more beneficial with 56% risk reduction (p < 0.01) of mortality compared with 33% risk reduction in the high-dose NSBB (p = 0.05). Conclusion: NSBB therapy was associated with longer survival in PP and SP groups who had an advanced stage of cirrhosis. Moreover, low-dose NSBB exhibited a better benefit than a standard-titrated high-dose NSBB with better tolerability.

Original languageEnglish
Pages (from-to)424-436
Number of pages13
JournalHepatology International
Volume15
Issue number2
DOIs
Publication statusPublished - 2021 Apr

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea grant funded by the Korean government (2017R1A5A2015369, 2018R1C1B5044890 and 2020R1F1A1072449).

Funding Information:
The authors acknowledge the assistance of the Regeneration Medicine Research Center and Mitohormesis Research Center of Yonsei University Wonju College of Medicine and all participants in the study.

Publisher Copyright:
© 2021, Asian Pacific Association for the Study of the Liver.

All Science Journal Classification (ASJC) codes

  • Hepatology

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