A comparative analysis of carvedilol and propranolol in hepatic venous pressure gradient reduction in patients with cirrhotic portal hypertension

Li Jing; Sun DongJie; Wang GuangChuan; Feng Hua; Shi YongJun; Zhang ChunQing

doi:10.3969/j.issn.1001-5256.2016.01.021

Volume 32 Issue 1

Jan. 2016

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2016 > 32(1): 114-118

PDF( 2061 KB)

A comparative analysis of carvedilol and propranolol in hepatic venous pressure gradient reduction in patients with cirrhotic portal hypertension

DOI: 10.3969/j.issn.1001-5256.2016.01.021

Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong University

Received Date: 2015-05-13
Published Date: 2016-01-20

Abstract

Abstract

Objective To investigate the differences between carvedilol and propranolol in the degree of hepatic venous pressure gradient( HVPG) reduction,response rate,and adverse events in patients with cirrhotic portal hypertension,and to evaluate the efficacy and safety of carvedilol in reducing portal vein pressure. Methods Sixty- four patients with cirrhotic portal hypertension who were diagnosed and treated in Shandong Provincial Hospital from October 2010 to January 2012 were selected and randomized into propranolol group( n = 33) and carvedilol group( n = 31). The dose of drugs was adjusted according to blood pressure and heart rate,and the course of treatment was 7 days. Measurements of HVPG and liver and renal function indices were performed before and after treatment,and the degree of HVPG reduction and response rate were compared between the two groups. The incidence of adverse events such as hypotension,ascites,and renal injury in the two groups was observed. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi- square test or Fisher's exact. Results HVPG was reduced significantly in both carvedilol group and propranolol group,with degrees of( 28. 30 ±22. 19) % and( 12. 38 ± 24. 09) %,respectively,and the reduction in the carvedilol group was significantly greater / higher / larger( t =0. 223 4,P = 0. 032). The response rate was 56. 7%( 17 /30) and 41. 9%( 13 /31) in the carvedilol group and propranolol group,respectively,with no significant difference between the two groups( χ2= 1. 324,P = 0. 250). The carvedilol group had a significantly more reduction in mean arterial pressure( MAP) than the propranolol group( t = 2. 338,P = 0. 024),but the patients did not experience the adverse event of hypotension. The levels of bilirubin,serum creatinine,and urea nitrogen did not change significantly before and after treatment,and there was no tendency of ascites formation or aggravation. Conclusion This randomized study suggests that within a short period of time,carvedilol is more effective than propranolol in reducing HVPG and has no obvious adverse effects. Carvedilol is safe and effective in the treatment of cirrhotic portal hypertension.
- liver cirrhosis,
- hypertension,portal,
- propranolol,
- carvedilol

FullText(HTML)

References(19)

References

[1]GARCIA-TSAO G,SANYAL AJ,GRACE ND,et al.Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J].Hepatology,2007,46(3):922-937.

[2]XU XQ,LI M.Influence of red sage and propranolol on portal hypertension rats'pressure,liver fibrosis and gastric-intestinal hormone[J].J Zhejiang Univ Tradit Chin Med,2010,34(3):312-313.(in Chinese)徐晓琦,李民.丹参、心得安对门静脉高压症大鼠门静脉压力、肝纤维化指标及胃肠激素的影响[J].浙江中医药大学学报,2010,34(3):312-313.

[3]LYU GX,ZHANG T,ZHOU ND,et al.Effects of carvedicol on plasma norepinephrine and myocardial IL-6 production in murine model with the coxsackievirus B3-induced viral myocarditis[J].Chin J Clin Pharmacol Ther,2013,18(12):1332-1337.(in Chinese)吕干新,张腾,周娜丹,等.卡维地洛对柯萨奇病毒B3感染小鼠儿茶酚胺及IL-6表达水平的影响[J].中国临床药理学与治疗学,2013,18(12):1332-1337.

[4]BOSCH J.Carvedilol for portal hypertension in patients with cirrhosis[J].Hepatology,2010,51(6):2214-2218.

[5]TSOCHATZIS EA,TRIANTOS CK,BURROUGHS AK.Gastrointestinal bleeding:carvedilol-the best beta-blocker for primary prophylaxis?[J].Nat Rev Gastroenterol Hepatol,2009,6(12):692-694.

[6]LA-MURA V,ABRALDES JG,RAFFA S,et al.Prognostic value of acute hemodynamic response to i.v.propranolol in patients with cirrhosis and portal hypertension[J].J Hepatol,2009,51(2):279-287.

[7]GE PS,RUNYON BA.The changing role of beta-blocker therapy in patients with cirrhosis[J].J Hepatol,2014,60(3):643-653.

[8]TRIPATHI D,HAYES PC.Beta-blockers in portal hypertension:new developments and controversies[J].Liver International,2014,34(5):655-667.

[9]DRASTICH P,LATA J,PETRTYL J,et al.Endoscopic variceal band ligation compared with propranolol for prophylaxis of first varical bleeding[J].Ann Hepatol,2011,10(6):142-149.

[10]LIANG CL,FAN XM.Effects of carvedilol on hepatic fibrosis[J].Chin J Gen Prac,2010,8(10):1211-1212.(in Chinese)梁春丽,樊晓明.卡维地洛抗肝纤维化的试验研究[J].中华全科医学,2010,8(10):1211-1212.

[11]BANARES R,MOITINHO E,MATILLA A,et al.Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis[J].Hepatology,2002,36(6):1367-1373.

[12]HOBOLTH L,BENDTSEN F,HANSEN EF,et al.Effects of carvedilol and propranolol on circulatory regulation and oxygenation in cirrhosis:a randomised study[J].Dig Liver Dis,2014,46(3):251-256.

[13]TRIPATHI D,FERGUSON JW,KOCHAR N,et al.Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed[J].Hepatology,2009,50(3):825-833.

[14]HEMSTREET BA.Evaluation of carvedilol for the treatment of portal hypertension[J].Pharmacotherapy,2004,24(1):94-104.

[15]HEMANDEZ-GEA V,ARACIL C,COLOMO A,et al.Development of ascites in compensated cirrhosis with severe portal hypertension treated withβ-blockers[J].Am J Gastroenterol,2012,107(3):418-427.

[16]SERSTE T,MELOT C,FRANCOZ C,et al.Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites[J].Hepatology,2010,52(3):1017-1022.

[17]SERSTE T,FRANCOZ C,DURAND F,et al.Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites:a cross-over study[J].J Hepatol,2011,55(4):794-799.

[18]BRUHA R,VITEK L,PETRTYL J,et al.Effect of carvedilol on portal hypertension depends on the degree of endothelial activation and inflammatory changes[J].Scand J Gastroenterol,2006,41(12):1454-1463.

[19]REIBERGER T,ULBRICH G,FERLITSCH A,et al.Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol[J].Gut,2013,62(11):1634-1641.

Relative Articles

[1]	Zhang ChunYu, Liu ZuoJin. Surgical treatment of cirrhotic portal hypertension: Current status and research advances[J]. Journal of Clinical Hepatology, 2020, 36(2): 417-420. doi: 10.3969/j.issn.1001-5256.2020.02.040
[2]	Yao Xin, Zhou Hao, Tang ShanHong, Huang Shan, Chen XueLing, Qin JianPing. Effect of intraoperative Viatorr stent implantation for shunting of blood flow in the left or right branch of the portal vein and its effect on clinical outcome in patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt[J]. Journal of Clinical Hepatology, 2020, 36(9): 1970-1974. doi: 10.3969/j.issn.1001-5256.2020.09.012
[3]	Mu XueChun, Wang Yu, Ma Hong. Noninvasive assessment of cirrhotic portal hypertension[J]. Journal of Clinical Hepatology, 2019, 35(12): 2796-2799. doi: 10.3969/j.issn.1001-5256.2019.12.033
[4]	Xiao Peng, Zhang YaNan, Ba TaoTao, Ding MengMeng, Gao YanHang. Application of serological markers in noninvasive assessment of cirrhotic portal hypertension[J]. Journal of Clinical Hepatology, 2019, 35(9): 2075-2078. doi: 10.3969/j.issn.1001-5256.2019.09.042
[5]	Xu Hui, Zhang Feng, Zhang Ming, Zhu GeYuZheng. Effect of propranolol on hemodynamics and its clinical significance in patients with portal hypertension[J]. Journal of Clinical Hepatology, 2019, 35(4): 801-807. doi: 10.3969/j.issn.1001-5256.2019.04.019
[6]	He Bo, Zhang ChunQing. Mechanism and current status of carvedilol in treatment of cirrhotic portal hypertension[J]. Journal of Clinical Hepatology, 2019, 35(2): 399-401. doi: 10.3969/j.issn.1001-5256.2019.02.036
[7]	Wang Lin, Xu JiPing, Liu Jing, Ma XianChun, Sun WenBing. Anesthetic management strategies for patients with cirrhotic portal hypertension[J]. Journal of Clinical Hepatology, 2018, 34(1): 188-191. doi: 10.3969/j.issn.1001-5256.2018.01.041
[8]	Niu XiaoWei, Liu TongTing, Wei Zhi. Advances in the effect of carvedilol in prevention and treatment of esophageal variceal bleeding in patients with cirrhosis[J]. Journal of Clinical Hepatology, 2018, 34(1): 184-187. doi: 10.3969/j.issn.1001-5256.2018.01.040
[9]	Han Dan, Qi XingShun, Yu Yang, Zhu Qiang, Guo XiaoZhong. An excerpt of portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis and management - 2016 practice guidance by the American Association for the Study of Liver Diseases[J]. Journal of Clinical Hepatology, 2017, 33(3): 422-427. doi: 10.3969/j.issn.1001-5256.2017.03.004
[10]	Nie Wei, Lin Wei, Liang Shan, Fan ZuoPeng, Chou LiXia, Liu YiRong, Ma LiXia, Wei XinHuan, Hu ZhongJie, Zhang Jing. Clinical features of cirrhotic patients with different degrees of portal vein thrombosis and their clinical significance[J]. Journal of Clinical Hepatology, 2017, 33(3): 472-475. doi: 10.3969/j.issn.1001-5256.2017.03.015
[12]	Ding Qian, Li Zhen, Liu Bin, Ling LiPing, Zhang ChunQing. Inhibitory effect of carvedilol on human hepatic stellate cell activation and fibrosis induced by platelet-derived growth factor-BB and related mechanisms of action[J]. Journal of Clinical Hepatology, 2017, 33(3): 485-491. doi: 10.3969/j.issn.1001-5256.2017.03.018
[13]	Zhai YaNan, Li Lei, Yin Liang, Guo QiHong, Lei JunQiang, Guo ShunLin, Zhang ChunYu, Wang HaiJun, Wen XiaoXiao. Role of dual-source CT low-dose whole liver perfusion imaging in evaluating liver blood perfusion after transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension[J]. Journal of Clinical Hepatology, 2016, 32(10): 1894-1899. doi: 10.3969/j.issn.1001-5256.2016.10.014
[14]	Bao HanKang, Wei XiuLi. Clinical effects of hand-assisted laparoscopic vs open splenectomy combined with pericardial devascularization the treatment of portal hypertension in liver cirrhosis[J]. Journal of Clinical Hepatology, 2015, 31(3): 431-433. doi: 10.3969/j.issn.1001-5256.2015.03.027
[15]	Lu XiaoMin, Wang ZhenNing, Yang Jun. Significance of molecular markers of prethrombotic state in monitoring portal vein thrombosis in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2015, 31(3): 404-406. doi: 10.3969/j.issn.1001-5256.2015.03.022
[16]	Yang ChunJiao, Qi XingShun, Guo XiaoZhong. Research advances in role of carvedilol in management of cirrhotic portal hypertension: a review of clinical trials[J]. Journal of Clinical Hepatology, 2015, 31(3): 469-471. doi: 10.3969/j.issn.1001-5256.2015.03.038
[17]	Duan LiWei, Sun Han, Chen YongSheng, Tian YueLi, Li DongFu. Hemodynamic effects of partial splenic artery embolization in patients with liver cirrhosis and portal hypertension[J]. Journal of Clinical Hepatology, 2013, 29(2): 142-145.
[18]	Shang JianZhong, Ma LongFei, Ma HongWei, Zhao QiuFang, Zhao LinHua, Li XiaoFei, Fan YanFeng, Zhang SuE. Effect of autologous bone marrow- derived mesenchymal stem cells on portal hemodynamics in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2013, 29(11): 848-851. doi: 10.3969/j.issn.1001-5256.2013.10.012

Supplements(0)

Cited By

Cited by

Periodical cited type(14)

1.	吴凤霞，王树俊. 卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张效果观察. 中国校医. 2022(05): 376-378 .
2.	辛国军，田明国，杨勇，李宝定，卜阳，刘明琦，张多强，王亚飞，蒋福东. 门静脉高压症术后经门静脉属支及颈内静脉留置导管测定门静脉压力梯度的体会. 中华普通外科杂志. 2022(06): 452-453 .
3.	田毅萍，蔡瑞君，王维. 卡维地洛与普萘洛尔治疗肝硬化合并食管胃底静脉曲张患者的临床研究. 中国临床药理学杂志. 2020(18): 2759-2761 .
4.	王省，吴斌. 中国肝硬化患者非选择性β受体阻滞剂使用若干问题的思考. 中华消化病与影像杂志(电子版). 2020(05): 193-195 .
5.	何搏，张春清. 卡维地洛治疗肝硬化门静脉高压症的作用机制及应用现状. 临床肝胆病杂志. 2019(02): 399-401 . 本站查看
6.	魏玮，相芳. 卡维地洛对肝硬化伴顽固性腹水患者门静脉血流动力学和存活质量的影响. 肝脏. 2019(08): 883-886 .
7.	曹海丹，黄寅，罗晓蓉，吴县斌. 卡维地洛与普萘洛尔治疗肝硬化门静脉高压的临床疗效及不良反应的对照研究. 北方药学. 2019(11): 138-140 .
8.	车寒蕊，李修岭，丁辉，江小柯. 肝硬化食管胃底静脉曲张出血的治疗进展. 世界最新医学信息文摘. 2019(93): 87-89 .
9.	许红华. 卡维地洛与普萘洛尔预防肝硬化并发食管静脉曲张首次破裂出血疗效比较. 实用肝脏病杂志. 2018(05): 673-676 .
10.	孙晓，孙万日. 卡维地洛对肝硬化上消化道出血的疗效分析. 热带医学杂志. 2018(08): 1099-1102 .
11.	李盼，朱萱，李弼民，郭贵海，王健，汪安江，游宇. 卡维地洛与普萘洛尔对肝硬化门静脉高压症疗效比较的Meta分析. 肝脏. 2018(06): 508-514 .
12.	刘晓军，王保海，王东平，孙静涛，周小森. 肝硬化患者肝功能分级及食管静脉曲张破裂出血的多层螺旋CT门静脉成像分析. 宁夏医科大学学报. 2018(07): 834-836 .
13.	叶冠男，王伟宁，黄萍，徐赛群. 普萘洛尔治疗门脉高压患者的效果及门静脉宽度变化的意义. 河北医药. 2017(05): 698-700 .
14.	杨国威，周英发. 特利加压素和奥曲肽对肝硬化患者HVPG、BFV的影响. 中国现代医学杂志. 2017(09): 99-103 .

Other cited types(6)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (2612) PDF downloads(442)

A comparative analysis of carvedilol and propranolol in hepatic venous pressure gradient reduction in patients with cirrhotic portal hypertension

DOI: 10.3969/j.issn.1001-5256.2016.01.021