Key result
Carvedilol was superior to propranolol in reducing the hepatic vein pressure gradient (MD -2.21; 95% CI -2.83 to -1.60; P<0.00001) in cirrhotic patients with portal hypertension.
Why the study?
Does carvedilol improve haemodynamic response compared to propranolol in cirrhotic patients with portal hypertension?
Meta-Analysis (n=153)
Does carvedilol improve haemodynamic response compared to propranolol in cirrhotic patients with portal hypertension?
Mean Difference: -2.21 (95% CI -2.83–-1.6)
p-value: p=< 0.00001
Carvedilol is more effective than propranolol in reducing the hepatic vein pressure gradient in cirrhotic patients with portal hypertension.
Carvedilol offers greater HVPG reduction than propranolol; supports preference as first-line NSBB for portal hypertension in cirrhosis.
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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Aguilar-Olivos et al. (2014) conducted a meta-analysis in Portal hypertension in cirrhotic patients (n=153). Carvedilol vs. Propranolol (10-320 mg/d) was evaluated on Haemodynamic response to treatment (decrease in hepatic vein pressure gradient) (MD -2.21, 95% CI -2.83 to -1.60, p=< 0.00001). Carvedilol was superior to propranolol in reducing the hepatic vein pressure gradient (MD -2.21; 95% CI -2.83 to -1.60; P<0.00001) in cirrhotic patients with portal hypertension.
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