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Updated: May 24, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Carvedilol or propranolol in portal hypertension? A randomized comparison
Lise Hobolth1, Søren Møller, Henning Grønbæk
1Department of Gastroenterology, Hvidovre University Hospital, Faculty of Health Sciences, Copenhagen University, Hvidovre, Denmark. lise@hobolth.dk
Insights
Carvedilol and propranolol equally reduce hepatic venous pressure gradient (HVPG) in cirrhosis patients long-term. An acute propranolol test does not reliably predict long-term HVPG response to either medication.
Area of Science:
- Hepatology
- Pharmacology
- Clinical Medicine
Background:
- Cirrhosis management often involves reducing hepatic venous pressure gradient (HVPG).
- Non-selective beta-blockers like propranolol are standard, but carvedilol's efficacy is under investigation.
- Carvedilol possesses additional alpha-1 blocking activity, potentially enhancing its effect on HVPG.
Purpose of the Study:
- To compare the long-term efficacy of carvedilol versus propranolol in reducing HVPG.
- To determine if an acute propranolol response predicts long-term HVPG reduction with either drug.
Main Methods:
- 38 cirrhosis patients with HVPG ≥ 12 mm Hg were randomized to carvedilol (21) or propranolol (17).
- HVPG was measured at baseline, 90 minutes after an 80mg oral propranolol dose, and after 90 days of treatment.
- A double-blind, randomized controlled trial design was employed.
Main Results:
- Both carvedilol and propranolol significantly reduced HVPG after 90 days (19.3% vs. 12.5%, respectively).
- No significant difference in long-term HVPG reduction was observed between carvedilol and propranolol groups (p=0.21).
- An acute HVPG decrease of ≥12% after propranolol did not reliably predict long-term response.
Conclusions:
- Carvedilol is as effective as propranolol for long-term HVPG reduction in cirrhosis.
- The acute propranolol response test is not a reliable predictor of long-term HVPG reduction with either carvedilol or propranolol.
Objectives:
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.
Material And 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.
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