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Scand J Gastroenterol. 2012 Apr;47(4):467-74. doi: 10.3109/00365521.2012.666673. Epub 2012 Mar 9.

Carvedilol or propranolol in portal hypertension? A randomized comparison.

Author information

1
Department of Gastroenterology, Hvidovre University Hospital, Faculty of Health Sciences, Copenhagen University, Hvidovre, Denmark. lise@hobolth.dk

Abstract

OBJECTIVES:

Carvedilol is a non-selective β-blocker with intrinsic anti-α(1)-adrenergic activity, potentially more effective than propranolol in reducing hepatic venous pressure gradient (HVPG). We compared the long-term effect of carvedilol and propranolol on HVPG and assessed whether the acute response to oral propranolol predicted the long-term HVPG response on either drug.

MATERIAL AND METHODS:

HVPG was measured in 38 patients with cirrhosis and HVPG ≥ 12 mm Hg at baseline and then again 90 min after an oral dose of 80 mg propranolol. Patients were double-blinded randomized to either carvedilol (21 patients) or propranolol (17 patients) and after 90 days of treatment HVPG measurements were repeated.

RESULTS:

HVPG decreased by 19.3 ± 16.1% (p < 0.01) and by 12.5 ± 16.7% (p < 0.01) in the carvedilol and propranolol groups, respectively, with no significant difference between treatment regimens (p = 0.21). Although insignificant, an acute decrease in HVPG of ≥12% was the best cut-off value to predict long-term HVPG response to propranolol when using ROC curve analysis.

CONCLUSIONS:

This randomized study showed that carvedilol is at least as effective as propranolol on HVPG after long-term administration. Furthermore, a predictive value of an acute propranolol test on HVPG could not be confirmed.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00493480.

PMID:
22401315
DOI:
10.3109/00365521.2012.666673
[Indexed for MEDLINE]

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