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Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis

Authors

  • Rafael Bañares,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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  • Eduardo Moitinho,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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  • Ana Matilla,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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  • Juan Carlos García-Pagán,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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  • José Luis Lampreave,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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  • Carlos Piera,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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  • Juan G. Abraldes,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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  • Alejandro De Diego,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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  • Agustín Albillos,

    1. Hepatic Hemodynamic Laboratory, Gastroenterology Department, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain
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  • Jaime Bosch M.D.

    Corresponding author
    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
    • Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. fax: (34) 932279856
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Abstract

Short-term carvedilol administration is more powerful than propranolol in decreasing hepatic venous pressure gradient (HVPG) in cirrhotic patients, but induces arterial hypotension that may prevent its long-term use in portal hypertensive patients. This study compared the HVPG reduction and safety of long-term carvedilol and propranolol. Fifty-one cirrhotic patients were randomly assigned to receive carvedilol (n = 26) and propranolol (n = 25). Hemodynamic measurements and renal function were assessed at baseline and after 11.1 ± 4.1 weeks. Carvedilol caused a greater decrease in HVPG than popranolol (− 19 ± 2% vs. − 12 ± 2%; P < 0.001). The proportion of patients achieving an HVPG reduction ⩾20% or ⩽ 20 mm Hg was greater after carvedilol (54% vs. 23%; P < 0.05). Carvedilol, but not propranolol caused a significant decrease in mean arterial pressure (MAP) (– 11 ± 1% vs. – 5 ± 3%; P = 0.05) and a significant increase in plasma volume (PV) and body weight (11 ± 5% and 2 ± 1%, respectively; P < 0.05). Glomerular filtration rate (GFR) was unchanged with either drug, but the dose of diuretics was increased more frequently after carvedilol (27% vs. 8% P = 0.07). Adverse events requiring discontinuation of treatment occurred in 2 patients receiving carvedilol and in 3 receiving propranolol. In conclusion, carvedilol has a greater portal hypotensive effect than propranolol in patients with cirrhosis. However, its clinical applicability may be limited by its systemic hypotensive effects. Further trials are needed to confirm the therapeutic potential of carvedilol. (HEPATOLOGY2002;36:1367–1373).

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