Villanueva C, et al. - In this investigator-initiated, double-blind, randomized controlled trial done in eight hospitals in Spain, researchers investigated if the risk of decompensation or death in compensated cirrhosis with clinically significant portal hypertension (CSPH) could be attenuated by lowering hepatic venous pressure gradient (HVPG) with β blockers. This study included cases with compensated cirrhosis and CSPH without high-risk varices. HVPG measurements were taken in all participants and acute HVPG-response to intravenous propranolol was evaluated. HVPG-decrease ≥10% defined responders, who were randomly administered propranolol (up to 160 mg twice a day) or placebo. Carvedilol (≤25 mg/day) or placebo were randomly given to non-responders. In patients with compensated cirrhosis and CSPH, an increased decompensation-free survival could be achieved with long-term treatment with β blockers, mostly due to the decreased incidence of ascites.