Carvedilol or propranolol in portal hypertension? A randomized comparison

Abstract

Objectives. Carvedilol is a non-selective β-blocker with intrinsic anti-α₁-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.

Key Words::

• acute HVPG response
• carvedilol
• portal pressure
• propranolol
• randomized trial

Declaration of interest: This study received funding support from Jacob & Olga Madsen's Foundation, Roche, the Research Foundation of Copenhagen Council, Hvidovre Hospital Foundation for Liver Disease, L.F. Foghts Foundation, DPHG and the Novo Nordisk Foundation.