Simvastatin combined with antiviral therapy for hepatitis B cirrhosis with portal hypertension: A case report

RATIONALE: Clinical management of hepatitis B cirrhosis complicated with portal hypertension remains challenging. nonselective beta-blockers like carvedilol, first-line agents, have notable limitations. While simvastatin may improve liver fibrosis and reduce portal hypertension, clinical evidence - especially regarding hepatic venous pressure gradient (HVPG) - is scarce. This study investigates the efficacy and safety of simvastatin combined with antiviral therapy in patients intolerant to carvedilol. PATIENT CONCERNS: Case 1: A 54-year-old male was admitted due to abnormal liver function for 2 weeks and fatigue with abdominal distension for 2 days. Vital signs were stable, with chronic liver disease facies, soft abdomen, positive hepatic percussion tenderness, no hepatosplenomegaly, and no ascites. Case 2: A 62-year-old male presented with intermittent fatigue for 3 months (aggravated for 1 week). His pulse rate was 49 beats per minute with mild dizziness (no chest tightness/pain), accompanied by chronic liver disease facies, liver palms, soft abdomen, positive hepatic percussion tenderness, and no ascites or bleeding. DIAGNOSES: Case 1: Compensated hepatitis B cirrhosis; Portal hypertension; Carvedilol-induced bradycardia. Case 2: Compensated hepatitis B cirrhosis; Portal hypertension; Sinus bradycardia. INTERVENTIONS: Basic treatment focused on HBV suppression, with portal hypertension management adjusted per contraindications and responses. Case 1 initially received carvedilol but switched to long-term simvastatin due to bradycardia. Case 2 was prescribed simvastatin upfront (given preexisting bradycardia); after self-discontinuing (HVPG increased), simvastatin was restarted for long-term maintenance. OUTCOMES: Nucleoside analogues (antiviral) plus simvastatin (reducing intrahepatic vascular resistance) effectively lowered portal venous pressure without drug-related adverse reactions. LESSONS: For hepatitis B cirrhosis patients with portal hypertension who are intolerant to or have contraindications for carvedilol, simvastatin combined with antiviral therapy is a safe, effective alternative. It significantly reduces HVPG, improves liver stiffness, and causes no obvious adverse events.