Acute and 7-day portal pressure response to carvedilol and propranolol in cirrhotics.
BACKGROUND
Carvedilol, a non-selective beta- and alpha-1 blocking agent, has portal hypotensive action. This study evaluates the acute and 7-day response to carvedilol, and compares it to that of propranolol.


METHODS
Thirty-six cirrhotics were randomized into two groups of 18 each, and treated with carvedilol or propranolol. Hepatic venous pressure gradient (HVPG) was measured before and 90 min after either 25 mg carvedilol or 80 mg propranolol was administered orally, and again 7 days after 12.5 mg carvedilol daily or 80 mg propranolol daily, respectively. 'Responders' were defined as those with HVPG reduction of > or = 20%.


RESULTS
With carvedilol, 11/18(61.1%) and 11/17(64.7%) patients responded acutely and after 7 days, respectively, while 9/18(50%) and 10/16(62.5%) did so to propranolol. However, HVPG reduction (percent) by carvedilol was not superior to that by propranolol either acutely (27.67 +/- 31.49 compared to 22.98 +/- 27.40, P = 0.6) or after 7 days (28.2 +/- 29.05 compared to 23.25 +/- 20.15, P = 0.6). With carvedilol, the acute HVPG response (P < 0.001) and responder status (P = 0.018) were good predictors of the response after 7 days, but were weak predictors in the case of propranolol (0.1 > P > 0.05 and P = 0.059, respectively). On carvedilol, only one patient (with ascites) developed symptomatic systemic hypotension with oliguria.


CONCLUSIONS
Carvedilol is a relatively safe, effective portal hypotensive agent, both acutely and over 7 days, but not superior to propranolol, at least in Indians. The acute hemodynamic response seems promising in predicting long-term response.
De
Binay K
BK
Department of Medicine, Istitute of Post Graduate Medical Education and Research, Calcutta, India. binaykde@apexmail.com
Das
Debasish
D
Sen
Sambit
S
Biswas
Pranab K
PK
Mandal
Sanjay K
SK
Majumdar
Debasis
D
Maity
Ajit K
AK
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D004311:Double-Blind Method; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects*; D011412:Propanolamines / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use; D012307:Risk Factors; D014690:Venous Pressure / Q000187:drug effects
D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol