Twelve RCTs (769 patients) were selected for analysis.
Beta-blockers significantly increased the mean percentage of patients free of rebleeding with a 21% mean improvement rate (95% confidence interval, CI: 10, 32, P<0.001), with a RR of rebleeding among patients not receiving treatment at 1.42. Five patients would need to be treated to prevent one rebleeding.
The percentage of patients free of variceal bleeding was significantly improved by the use of beta-blockers over the control, with a 20% mean improvement rate (95% CI: 11, 28, P<0.001). Compared with treated patients, the RR of variceal bleeding among patients without treatment was 1.40. Six patients would need to be treated to prevent one episode of rebleeding.
Compared to the control, the use of beta-blockers significantly improved survival with a mean improvement rate of 5.4% (95% CI: 0%,11%, P=0.05). Compared with treated patients, the RR of death among patients without treatment was 1.27. Fourteen patients would need to be treated to prevent one death.
The percentage of patients free from bleeding death was significantly lower for patients treated with beta-blockers, compared to the control, with a mean difference of 7.4% (95% CI: 2, 13, P<0.01). Compared with treated patients, the RR of death from bleeding among patients without treatment was 1.50. Thirteen patients would need to be treated to prevent one death from bleeding. Adverse events were significantly higher among patients treated with beta-blockers, compared to the control, with a mean rate difference of 10% (95% CI: 6, 16, P<0.001).
There was no significant heterogeneity among the studies.