The portal pressure response to beta-blockade is greater in cirrhotic patients without varices than in those with varices

Background & Aims: Nonselective beta-blockers are effective in reducing portal pressure in cirrhotic patients. However, this beneficial effect is highly variable and may depend on the extent of portal system collateralization. The aim of this study was to compare portal pressure response with timolol, a nonselective beta-blocker, in cirrhotic patients with and without varices. Methods: Portal and systemic hemodynamics were measured before and after a single oral dose of 10 mg of timolol in 50 patients with cirrhosis and portal hypertension, 15 with and 35 without esophageal varices. Results: Timolol significantly decreased portal pressure in all patients (mean reduction, 20% +/- 13%; P < 0.0001), The reduction in hepatic venous pressure gradient was greater in patients without varices (- 24% +/- 14%) than in those with varices (-12% +/- 8%) (P < 0.01), A decrease in the hepatic venous pressure gradient of <12 mm Hg was achieved in 7 of 12 (58%) patients without varices and a baseline pressure gradient of greater than or equal to 12 mm Hg, but only in 3 of 15 patients with varices (20%) (P < 0.01), Conclusions: Timolol is effective in reducing portal pressure in cirrhotic patients, more so in patients without varices, suggesting that nonselective beta-blockers will be more effective in the treatment of portal hypertension when administered at early stages, before the development of varices.