title: Is it time to replace propranolol with carvedilol for portal hypertension?
abstract: Beta-adrenergic receptor antagonists (β-blockers) have been well established for use in portal hypertension for more than three decades. Different Non-selective β-blockers like propranolol, nadolol, timolol, atenolol, metoprolol and carvedilol have been in clinical practice in patients with cirrhosis. Carvedilol has proven 2-4 times more potent than propranolol as a beta-receptor blocker in trials conducted testing its efficacy for heart failure. Whether the same effect extends to its potency in the reduction of portal venous pressures is a topic of on-going debate. The aim of this review is to compare the hemodynamic and clinical effects of carvedilol with propranolol, and attempt assess whether carvedilol can be used instead of propranolol in patients with cirrhosis. Carvedilol is a promising agent among the beta blockers of recent time that has shown significant effects in portal hypertension hemodynamics. It has also demonstrated an effective profile in its clinical application specifically for the prevention of variceal bleeding. Carvedilol has more potent desired physiological effects when compared to Propranolol. However, it is uncertain at the present juncture whether the improvement in hemodynamics also translates into a decreased rate of disease progression and complications when compared to propranolol. Currently Carvedilol shows promise as a therapy for portal hypertension but more clinical trials need to be carried out before we can consider it as a superior option and a replacement for propranolol.
authors.affiliation: Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
authors.affiliation: Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
authors.forename: Saadat
authors.initials: S
authors.lastname: Ali
authors.affiliation: Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
authors.forename: Muhammad Asif
authors.initials: MA
authors.lastname: Baig
authors.affiliation: Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
authors.forename: Anam Akbar
authors.initials: AA
authors.lastname: Waheed
keywords: Carvedilol; Chronic liver disease; Non-selective beta-blockers; Portal hypertension; Propranolol