{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:34:43Z","timestamp":1791520483505,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T00:00:00Z","timestamp":1564704000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The safety of non\u2010selective \u03b2\u2010blockers in patients with advanced cirrhosis has been questioned in recent years. It was hypothesised that there is a particular therapeutic window. However, the specific limits still need to be determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate potential limits of the therapeutic window of non\u2010selective \u03b2\u2010blocker therapy in patients with cirrhosis and ascites<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The impact of non\u2010selective \u03b2\u2010blockers on 28\u2010day transplant\u2010free survival was analysed in a cohort of 624 consecutive patients with decompensated cirrhosis and ascites. Three potential limits were investigated: spontaneous bacterial peritonitis, acute\u2010on\u2010chronic liver failure, mean arterial blood pressure\u00a0\u2264\u00a082 and\u00a0&lt;\u00a065\u00a0mm Hg.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Treatment with non\u2010selective \u03b2\u2010blockers was associated with a higher 28\u2010day transplant\u2010free survival in the overall cohort (hazard ratio: 0.621; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.035) as well as in patients with acute\u2010on\u2010chronic liver failure (hazard ratio: 0.578; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.031) and those with spontaneous bacterial peritonitis (hazard ratio: 0.594; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.073). In contrast, survival benefits were markedly attenuated in patients with a mean arterial blood pressure\u00a0\u2264\u00a082\u00a0mm Hg and completely lost in those with mean arterial blood pressure\u00a0&lt;\u00a065\u00a0mm Hg (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.536). In spontaneous bacterial peritonitis patients with a mean arterial blood pressure\u00a0&lt;\u00a065\u00a0mm Hg non\u2010selective \u03b2\u2010blocker treatment was associated with renal impairment. Of note, among those with a mean arterial blood pressure\u00a0\u2265\u00a065\u00a0mm Hg non\u2010selective \u03b2\u2010blocker intake was consistently associated with superior transplant\u2010free survival (hazard ratio: 0.582; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.029) irrespective of the presence of spontaneous bacterial peritonitis (hazard ratio: 0.435; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.028) or acute\u2010on\u2010chronic liver failure (hazard ratio: 0.480 <jats:italic>P<\/jats:italic>\u00a0=\u00a0.034).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ascites, acute\u2010on\u2010chronic liver failure and spontaneous bacterial peritonitis do not limit the safe use of non\u2010selective \u03b2\u2010blockers in patients with cirrhosis. Mean arterial blood pressure might represent a better indicator to determine the therapeutic window of non\u2010selective \u03b2\u2010blocker treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.15439","type":"journal-article","created":{"date-parts":[[2019,8,2]],"date-time":"2019-08-02T14:09:03Z","timestamp":1564754943000},"page":"696-706","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Systemic arterial blood pressure determines the therapeutic window of non\u2010selective beta blockers in decompensated cirrhosis"],"prefix":"10.1111","volume":"50","author":[{"given":"Tammo L.","family":"Tergast","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kimmann","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, 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