Beta blocker therapy in liver cirrhosis: ending treatment at the right time can increase length of survival
(Vienna, 15th April 2014) Treatment with beta blockers is useful in cases of liver cirrhosis up to a certain stage of the disease, but after this life expectancy tails off markedly. Existing treatment regimens therefore need to be adapted. This is the core message emanating from a recent study carried out at the MedUni Vienna.
As part of the study recently published in the highly respected journal Gastroenterology, the specialism’s leading publication, the team of the Vienna Portal Hypertension Study Group led by Mattias Mandorder and Thomas Reiberger at the MedUni Vienna investigated the effect of beta blocker therapy on the development of complications and survival in patients with advanced liver cirrhosis.
The study investigated the effects of beta blocker therapy in 607 patients with liver cirrhosis and ascites, one of the serious complications of liver cirrhosis. In light of the study results, beta blocker therapy is to be stopped immediately in the event of an ascites infection, or peritonitis.
New definition of the therapeutic window for beta blocker therapy
The results of the study therefore show that, in contrast to previous recommendations, treatment with beta blockers is only recommended up to a certain stage of the disease. Mandorfer explains the point at which this stage comes as follows: “The study shows that the occurrence of peritonitis closes the therapeutic window for beta blocker therapy. Otherwise, the survival period of this group of patients is at marked risk, due to side effects such as severe blood pressure drop and renal function impairment.
Beta blockers: desired effect and unwanted side-effects
Reduced blood pressure in the portal vein is one of the desired effects of beta blocker therapy, which is why beta blockers have been used for decades to treat portal hypertension in patients with liver cirrhosis. This is because the majority of serious complications that occur in patients with liver cirrhosis are triggered by the development of portal vein hypertension. Alongside the treatment of the underlying condition, beta blockers are currently the only medication-based treatment option for portal hypertension.
The flip side, however, is that although patients with early or not very advanced liver cirrhosis generally demonstrate normal or slightly lower blood pressure levels, and therefore have an adequate blood pressure reserve, patients with advance liver cirrhosis generally have a significantly lower blood pressure even without beta blocker therapy.
Ascites infection markedly increases the burden on the circulatory system
The onset of ascites increases the burden on the circulatory system markedly. Thomas Reiberger from the Vienna Portal Hypertension Study Group says: “The additional development of an ascites infection represents a major burden on the circulatory system. Patients in our study with infections of this kind had much lower blood pressure levels than patients who were not on beta blocker therapy.” As a result, patients receiving beta blocker therapy at the time of the ascites infection had far more life-threatening complications, in particular impairment of their renal function.
Vienna leads the way internationally in the research and treatment of liver disease
The team of the Vienna Portal Hypertension Study Group (led by Markus Peck-Radosavljevic) at the MedUni Vienna has highlighted the leading role played by hepatology in Vienna among the international scientific community with this study. Crucial in the development of the study were not only the Vienna Portal Hypertension Study Group from the Clinical Department of Gastroenterology and Hepatology (departmental head: Michael Trauner) at the University Department of Internal Medicine III, but also the University Department of Hospital Hygiene and Infection Control and the Institute of Medical Statistics at the MedUni Vienna.
“Non-selective β Blockers Increase Risk for Hepatorenal Syndrome and Death in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis.” Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, Hagmann M, Blacky A, Ferlitsch A, Sieghart W, Trauner M, Peck-Radosavljevic M, Reiberger T: Gastroenterology 2014 Mar 12. pii: S0016-5085(14)00306-0. doi: 10.1053/j.gastro.2014.03.005. [Epub ahead of print]. PMID 24631577.