Do all patients with chronic liver disease need to be treated with Beta-Blockers?
The beta-blocker window hypothesis postulates that the use of non-selective beta-blockers in patients with chronic liver disease is associated with improved survival rates only if certain criteria are met and if they are used outside that window period, they may be associated with increased mortality and morbidity.
Patients who are candidates to benefit from using beta-blockers include:
It is thus recommended to avoid using beta-blockers in patients who have advanced cirrhosis with refractory ascites and the following clinical parameters:
Diuretic-refractory or diuretic intolerant ascites as in patients with renal dysfunction, hyponatremia, and hepatic encephalopathy,
Cardiac index of 1.5 L/min/m² or less,
Systolic blood pressure less than or equal to 90 mm Hg,
Within six months after the first episode of spontaneous bacterial peritonitis.