Cirrhosis: Beta-Blockers for Portal Hypertension and Varices

Topic Overview

In people who have cirrhosis, portal hypertension causes many problems. One serious complication is bleeding of enlarged veins, or varices, in the digestive tract (variceal bleeding).

When the buildup of scar tissue caused by cirrhosis reduces the flow of blood through the liver, pressure may build up in the portal vein system, which filters blood from the intestines through the liver. In turn, veins in the esophagus, stomach, and rectum may enlarge to accommodate the pressure from the blocked blood flow. The walls of these expanded veins become thin and may rupture and bleed.

One way to prevent an episode of variceal bleeding is to lower the blood pressure in the enlarged veins. By slowing the heart rate and widening the blood vessels, beta-blocker medicines such as propranolol and nadolol appear to lower the blood pressure in varices that bypass the liver. In people who have esophageal varices, beta-blockers have been shown to reduce the risk of having a first episode of bleeding.^{footnote 1} They are usually prescribed for people who have moderate-to-large varices.

Beta-blockers may cause side effects that lead people to stop taking them. Common side effects can include fatigue and dizziness. Less common side effects can include asthma getting worse, nightmares, or confusion. Rapid heart rate and high blood pressure can occur if the medicine is withdrawn suddenly. Studies have shown that for people who have high-risk varices and cannot take beta-blockers because of side effects, other treatment options such as variceal banding may be a better choice.^{footnote 1}