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Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis
Nancy Aguilar-Olivos1, Miguel Motola-Kuba1, Roberto Candia2
1Medica Sur Clinic & Foundation, Mexico City, Mexico.
Insights
Carvedilol shows greater effectiveness than propranolol in reducing hepatic vein pressure gradient for patients with portal hypertension. Further long-term studies are needed to confirm these findings on hemodynamic response.
Area of Science:
- Hepatology
- Cardiology
- Pharmacology
Background:
- Portal hypertension is a complication of cirrhosis.
- Non-selective beta-blockers are standard treatment.
- Carvedilol's efficacy compared to propranolol needs further investigation.
Purpose of the Study:
- To compare carvedilol and propranolol in treating portal hypertension.
- To assess effects on systemic and splanchnic hemodynamics.
- To evaluate adverse events of both treatments.
Main Methods:
- Systematic review adhering to Cochrane and PRISMA guidelines.
- Included randomized controlled trials comparing carvedilol vs. propranolol.
- Primary outcome was hemodynamic response, specifically hepatic vein pressure gradient (HVPG).
Main Results:
- Four trials with 153 patients (79 carvedilol, 74 propranolol) were analyzed.
- Carvedilol significantly reduced HVPG more than propranolol (MD -2.21; P < 0.00001).
- Carvedilol was superior in achieving target HVPG reduction (OR: 2.93; P = 0.002), with similar adverse events.
Conclusions:
- Limited evidence suggests carvedilol is more effective than propranolol for improving hemodynamic response in cirrhotic patients with portal hypertension.
- Carvedilol demonstrates superior efficacy in reducing HVPG.
- Long-term randomized controlled trials are necessary to confirm these findings.
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.
Material And 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.
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