title: Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis.
abstract: BACKGROUND
  Carvedilol appears to be more effective than propranolol in the treatment of portal hypertension in cirrhotic patients. Aim. To compare the effects of carvedilol vs. propranolol on systemic and splanchnic haemodynamics and to evaluate the adverse events associated with these treatments.
  
  
  METHODS
  We performed a systematic review following the Cochrane and PRISMA recommendations. Randomised controlled trials comparing carvedilol versus propranolol, in the treatment of portal hypertension in cirrhotic patients with oesophageal varices, with or without bleeding history were included. The primary outcome measure was the haemodynamic response to treatment.
  
  
  RESULTS
  Four randomised trials and 153 patients were included; 79 patients received carvedilol (6.25-50 mg/d) and 74 patients received propranolol (10-320 mg/d). The hepatic vein pressure gradient (HVPG) decreased more with carvedilol than with propranolol (MD -2.21; 95% CI: -2.83 to -1.60, I(2) = 0%, P < 0.00001). Carvedilol was superior to propranolol for reducing HVPG by ≥ 20% from the baseline value or to ≤ 12 mmHg (OR: 2.93; 95% CI: 1.50 to 5.74, I(2) = 22%, P = 0.002). Overall adverse events did not differ between. In conclusion, there is limited evidence suggesting that carvedilol is more effective than propranolol for improving the haemodynamic response in cirrhotic patients with portal hypertension. Long-term randomized controlled trials are needed to confirm this information.
authors.affiliation: Medica Sur Clinic & Foundation, Mexico City, Mexico.
authors.forename: Nancy
authors.initials: N
authors.lastname: Aguilar-Olivos
authors.affiliation: Medica Sur Clinic & Foundation, Mexico City, Mexico.
authors.forename: Miguel
authors.initials: M
authors.lastname: Motola-Kuba
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Roberto
authors.initials: R
authors.lastname: Candia
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Marco
authors.initials: M
authors.lastname: Arrese
authors.affiliation: Medica Sur Clinic & Foundation, Mexico City, Mexico.
authors.forename: Nahúm
authors.initials: N
authors.lastname: Méndez-Sánchez
authors.affiliation: Medica Sur Clinic & Foundation, Mexico City, Mexico.
authors.forename: Misael
authors.initials: M
authors.lastname: Uribe
authors.affiliation: Medica Sur Clinic & Foundation, Mexico City, Mexico.
authors.forename: Norberto C
authors.initials: NC
authors.lastname: Chávez-Tapia
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology; D006439:Hemodynamics / Q000502:physiology; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011412:Propanolamines / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*; D013152:Splanchnic Circulation / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol