A comparative analysis of carvedilol and propranolol in hepatic venous pressure gradient reduction in patients with cirrhotic portal hypertension

Objective To investigate the differences between carvedilol and propranolol in the degree of hepatic venous pressure gradient( HVPG) reduction,response rate,and adverse events in patients with cirrhotic portal hypertension,and to evaluate the efficacy and safety of carvedilol in reducing portal vein pressure. Methods Sixty- four patients with cirrhotic portal hypertension who were diagnosed and treated in Shandong Provincial Hospital from October 2010 to January 2012 were selected and randomized into propranolol group( n = 33) and carvedilol group( n = 31). The dose of drugs was adjusted according to blood pressure and heart rate,and the course of treatment was 7 days. Measurements of HVPG and liver and renal function indices were performed before and after treatment,and the degree of HVPG reduction and response rate were compared between the two groups. The incidence of adverse events such as hypotension,ascites,and renal injury in the two groups was observed. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi- square test or Fisher's exact. Results HVPG was reduced significantly in both carvedilol group and propranolol group,with degrees of( 28. 30 ±22. 19) % and( 12. 38 ± 24. 09) %,respectively,and the reduction in the carvedilol group was significantly greater / higher / larger( t =0. 223 4,P = 0. 032). The response rate was 56. 7%( 17 /30) and 41. 9%( 13 /31) in the carvedilol group and propranolol group,respectively,with no significant difference between the two groups( χ2= 1. 324,P = 0. 250). The carvedilol group had a significantly more reduction in mean arterial pressure( MAP) than the propranolol group( t = 2. 338,P = 0. 024),but the patients did not experience the adverse event of hypotension. The levels of bilirubin,serum creatinine,and urea nitrogen did not change significantly before and after treatment,and there was no tendency of ascites formation or aggravation. Conclusion This randomized study suggests that within a short period of time,carvedilol is more effective than propranolol in reducing HVPG and has no obvious adverse effects. Carvedilol is safe and effective in the treatment of cirrhotic portal hypertension.