DOI: 10.1097/01.sa.0000234709.37860.e7
,
Issn Print: 0039-6206
Publication Date: 2006/08/01
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Excerpt
Roberto J. Groszmann,* Guadalupe Garcia-Tsao,* Jaime Bosch,† Norman D. Grace,‡§ Andrew K. Burroughs,∥ Ramon Planas,¶ Angels Escorsell,† Juan Carlos Garcia-Pagan,† David Patch,∥ Daniel S. Matloff,§ Hong Gao,† and Robert Makuch,† for the Portal Hypertension Collaborative Group
(N Engl J Med, 353:2254-2261, 2005)
*Veterans Affairs Connecticut Healthcare System, West Haven, CT; †Hospital Clinic I Provincial de Barcelona, Barcelona, Spain; ‡Brigham and Women's Hospital, Boston, MA; §Faulkner Hospital, Jamaica Plain, MA; ∥Royal Free Hospital and School of Medicine, London Hospital, London, UK and ¶Hospital Germans Trias I Pujol, Barcelona, Spain.
Although their effectiveness in preventing varices is not known, nonselective beta-adrenergic blockers lower portal pressure and prevent variceal hemorrhage. Two hundred thirteen patients with cirrhosis and portal hypertension (minimal hepatic venous pressure gradient [HVPG] of 6 mm Hg) were randomly assigned to receive timolol, a nonselective beta-blocker (108 patients) or placebo (105 patients). The primary end point was the development of gastroesophageal variceal hemorrhage. Endoscopy and HVPG were repeated annually. During a median follow-up of 54.9 months, the rate of the primary end point did not differ markedly between the timolol and placebo groups (39% and 40%, respectively), nor were there marked differences in the rates of ascites, encephalopathy, liver transplantation, or death. Serious adverse events were more common among patients in the timolol group than among those in the placebo group (18% vs. 6%). Varices occurred less often among patients with a baseline HVPG <10 mm Hg and among those in whom the HVPG decreased by more than 10% at 1 year. The investigators concluded that nonselective beta-blockers are not effective in preventing varices in unselected patients with cirrhosis and portal hypertension and are associated with a greater number of adverse events.
