AI Article Synopsis
- Propranolol effectively decreases portal pressure in cirrhotic patients, but some do not respond; combining it with isosorbide-5-mononitrate may improve outcomes.
- Carvedilol, a nonselective beta-blocker, shows a greater reduction in portal pressure compared to propranolol and isosorbide-5-mononitrate in patients with cirrhosis.
- A study revealed that carvedilol led to a more significant decrease in hepatic venous pressure gradient (HVPG) and increased hepatic blood flow, indicating it might be a better treatment option for patients with viral cirrhosis compared to the propranolol combination.
Article Abstract
Objective: Propranolol is known to decrease portal pressure in cirrhotic patients with portal hypertension; however, a substantial number of patients do not respond to propranolol administration. The addition of isosorbide-5-mononitrate may enhance portal pressure reduction in patients receiving propranolol. Carvedilol is a nonselective beta-blocker with alpha(1)-adrenergic blocking activity. It has been shown to decrease portal pressure in cirrhotic patients. Additionally, carvedilol has a greater portal hypotensive effect than propranolol alone in patients with cirrhosis. The current study is aimed at comparing the acute hemodynamic effects of carvedilol with the effects of propranolol plus isosorbide-5-mononitrate in patients with viral cirrhosis.
Methods: Patients with viral cirrhosis were randomly assigned to receive an oral administration of carvedilol of 25 mg (n = 11) or an oral administration of propranolol 40 mg plus isosorbide-5-mononitrate 20 mg (n = 11). Hemodynamic values were measured at basal and 90 min after drugs administration.
Results: Both carvedilol and propranolol plus isosorbide-5-mononitrate significantly decreased cardiac index, heart rate, and HVPG. The magnitude of changes in HVPG observed between the basal and after drugs administration was greater in patients receiving carvedilol than in those receiving propranolol plus isosorbide-5-mononitrate (-18.6 +/- 3.6%vs-10.1 +/- 3.6%, p < 0.05). Hepatic blood flow increased following carvedilol administration but remained unchanged in patients receiving propranolol plus isosorbide-5-mononitrate. The magnitude of decrease in mean arterial pressure (MAP) did not differ between the two groups of patients.
Conclusion: In our patients with viral cirrhosis, carvedilol is more effective than propranolol plus isosorbide-5-mononitrate in the reduction of HVPG. Carvedilol administration causes an increase in hepatic blood flow, but its systemic effects were similar to those of propranolol plus isosorbide-5-mononitrate.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/j.1572-0241.2004.40179.x | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Carvedilol for prevention of variceal bleeding: a systematic review and meta-analysis.
Ann Gastroenterol
March 2019
Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Background: Beta-blockers are used for prophylaxis of variceal bleeding. Our aim was to assess the efficacy and safety of carvedilol for primary or secondary prevention of variceal bleeding in patients with cirrhosis.
Methods: We searched Medline, Embase, CENTRAL and gray literature sources for randomized controlled trials (RCTs) comparing carvedilol with placebo or any active intervention.
Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis.
BMJ Open
May 2016
Hepatobiliary Surgery Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Objective: To assess the clinical and haemodynamic effects of carvedilol for patients with cirrhosis and portal hypertension.
Design: A systematic review and meta-analysis.
Data Sources: We searched PubMed, Cochrane library databases, EMBASE and the Science Citation Index Expanded through December 2015.
Prevention of Rebleeding From Esophageal Varices in Patients With Cirrhosis Receiving Small-Diameter Stents Versus Hemodynamically Controlled Medical Therapy.
Gastroenterology
September 2015
Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
Background & Aims: Patients with cirrhosis and variceal hemorrhage have a high risk of rebleeding. We performed a prospective randomized trial to compare the prevention of rebleeding in patients given a small-diameter covered stent vs those given hepatic venous pressure gradient (HVPG)-based medical therapy prophylaxis.
Methods: We performed an open-label study of patients with cirrhosis (92% Child class A or B, 70% alcoholic) treated at 10 medical centers in Germany.
Combined therapies versus monotherapies for the first variceal bleeding in patients with high-risk varices: a meta-analysis of randomized controlled trials.
J Gastroenterol Hepatol
March 2014
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China.
Background And Aim: The effect of combined therapies (among non-selected beta-blockers [NSBB], endoscopic therapy, and other treatments) on the first variceal bleeding has been evaluated in several randomized controlled trials previously, and the results were controversial. We performed this meta-analysis to assess the effect of combined therapies in patients with high-risk varices without previous variceal bleeding.
Methods: The Cochrane Library, The Cochrane Hepato-Biliary Group Controlled Trials Register, MEDLINE, and EMBASE were searched for eligible trials.
Effects of propranolol or propranolol plus isosorbide-5-mononitrate on variceal pressure in schistosomiasis.
World J Gastroenterol
July 2013
Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
Aim: To compare the effects of propranolol (PR) to that of PR plus isosorbide-5-mononitrate (ISMN) on variceal pressure in patients with schistosomiasis.
Methods: Forty-eight patients with schistosomiasis who had no previous variceal bleeding were treated with PR alone or PR plus ISMN. Seven patients refused variceal pressure manometry (3 receiving PR and 4 receiving PR plus ISMN).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!