Non selective beta-blocker in cirrhosis: not ‘whether’ but ‘who and how’

Non selective beta-blockers (NSBBs) have been used for decades in patients with liver cirrhosis to reduce portal pressure and the risk for portal hypertensive bleeding (1-3). International guidelines recommend NSBB as primary and secondary prophylaxis for variceal bleeding in cirrhosis (4).
Patients with liver cirrhosis and portal hypertension have a distinct pathophysiological feature dominated by a hyperdynamic circulation (5).