title: Carvedilol or propranolol in portal hypertension? A randomized comparison.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Gastroenterology, Hvidovre University Hospital, Faculty of Health Sciences, Copenhagen University, Hvidovre, Denmark. lise@hobolth.dk
authors.forename: Lise
authors.initials: L
authors.lastname: Hobolth
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
authors.forename: Henning
authors.initials: H
authors.lastname: Grønbæk
authors.forename: Klaus
authors.initials: K
authors.lastname: Roelsgaard
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
authors.forename: Erik
authors.initials: E
authors.lastname: Feldager Hansen
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D004311:Double-Blind Method; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects; D011237:Predictive Value of Tests; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014690:Venous Pressure / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol