title: Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis.
abstract: To assess the clinical and haemodynamic effects of carvedilol for patients with cirrhosis and portal hypertension.
  
  
  
  A systematic review and meta-analysis.
  
  
  
  We searched PubMed, Cochrane library databases, EMBASE and the Science Citation Index Expanded through December 2015. Only randomised controlled trials (RCTs) were included.
  
  
  
  We calculated clinical outcomes (all-cause mortality, bleeding-related mortality, upper gastrointestinal bleeding) as well as haemodynamic outcomes (hepatic venous pressure (HVPG) reduction, haemodynamic response rate, post-treatment arterial blood pressure (mean arterial pressure; MAP) and adverse events).
  
  
  
  12 RCTs were included. In 7 trials that looked at haemodynamic outcomes compared carvedilol versus propranolol, showing that carvedilol was associated with a greater reduction (%) of HVPG within 6 months (mean difference -8.49, 95% CI -12.36 to -4.63) without a greater reduction in MAP than propranolol. In 3 trials investigating differences in clinical outcomes between carvedilol versus endoscopic variceal band ligation (EVL), no significant differences in mortality or variceal bleeding were demonstrated. 1 trial compared clinical outcomes between carvedilol versus nadolol plus isosorbide-5-mononitrate (ISMN), and showed that no significant difference in mortality or bleeding had been found. 1 trial comparing carvedilol versus nebivolol showed a greater reduction in HVPG after 14 days follow-up in the carvedilol group.
  
  
  
  Carvedilol may be more effective in decreasing HVPG than propranolol or nebivolol and it may be as effective as EVL or nadolol plus ISMN in preventing variceal bleeding. However, the overall quality of evidence is low. Further large-scale randomised studies are required before we can make firm conclusions.
  
  
  
  CRD42015020542.
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Li
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Ke
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Chen
authors.affiliation: HPB and Liver Transplant Surgery, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Belgaumkar
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Yuanjian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Anesthesia Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Xian
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jinjin
authors.initials: J
authors.lastname: Li
authors.affiliation: Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Qichang
authors.initials: Q
authors.lastname: Zheng
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D004305:Dose-Response Relationship, Drug; D004932:Esophageal and Gastric Varices / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000473:pathology; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000473:pathology; D011412:Propanolamines / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol
keywords: CLINICAL PHARMACOLOGY; GENERAL MEDICINE (see Internal Medicine)