Nonselective beta-adrenergic blockers decrease portal pressure and prevent variceal hemorrhage. Their effectiveness in preventing varices is unknown.
Dr Groszmann and colleagues included 213 patients with cirrhosis and portal hypertension.
The research team randomized 108 patients to receive timolol, a nonselective beta-blocker, or 105 to placebo.
The primary end point was the development of gastroesophageal varices or variceal hemorrhage.
The researchers repeated endoscopy and hepatic venous pressure gradient measurements yearly.
During a median follow-up of 55 months, the rate of the primary end point did not differ significantly between the timolol group and the placebo group.
The researchers also found no significant differences in the rates of ascites, or encephalopathy.
|Serious adverse events occurred in 18% of patients in the timolol group|
|New England Journal of Medicine|
In addition, the team observed no differences in liver transplantation, or death between the 2 groups.
Serious adverse events occurred in 18% of patients in the timolol group and 6% in the placebo group.
Varices developed less frequently among patients with a baseline hepatic venous pressure gradient of less than 10 mm Hg.
The researchers noted that varices were also less frequent among those in whom the hepatic venous pressure gradient decreased by more than 10% in a year.
The team found varices more frequently among those in whom the hepatic venous pressure gradient increased by more than 10% at one year.
Dr Groszmann's team concluded, “Nonselective beta-blockers are ineffective in preventing varices in unselected patients with cirrhosis and portal hypertension and are associated with an increased number of adverse events.”