1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Can ß-Blockers Prevent Gastroesophageal Varices?

Although nonselective beta-blockers reduce the incidence of bleeding in patients with cirrhosis who already have varices, they failed to prevent varices from developing in this randomized trial.

Nonselective ß-blockers reduce the incidence of bleeding in patients with cirrhosis who have gastroesophageal varices. However, whether ß-blockers can prevent the development of varices is unclear.

In this randomized trial, researchers enrolled 213 patients with cirrhosis and portal hypertension (i.e., hepatic venous pressure gradient [HVPG] 6 mm Hg), but with no endoscopic evidence of gastroesophageal varices. Patients received either the nonselective ß-blocker timolol (dosed to reduce heart rate by 25% or to <55 beats/min) or placebo, and underwent repeat endoscopy yearly. During a median follow-up of 55 months, the proportions of patients who developed varices or variceal bleeding were virtually identical in the timolol and placebo groups (39% vs. 40%). Frequencies of secondary endpoints (e.g., death, ascites, encephalopathy) were also similar in the two groups. Adverse events rated as serious occurred significantly more often in the timolol group (18% vs. 6%).

Development of varices or variceal bleeding correlated with baseline HVPG and with changes in HVPG over time. Although timolol did reduce the average HVPG more than placebo did, the difference did not reach statistical significance.

Comment: In this study, a nonselective ß-blocker did not prevent varices; for now, clinicians should not prescribe ß-blockers for this purpose. However, the results imply that more effective and safer agents to lower the hepatic venous pressure gradient might well prevent the development of varices.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 9, 2005

Citation(s):

Groszmann RJ et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005 Nov 24; 353:2254-61.

• Original article (Subscription may be required)
• Medline abstract (Free)