Journal
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY
Volume 47, Issue 4, Pages 467-474Publisher
TAYLOR & FRANCIS LTD
DOI: 10.3109/00365521.2012.666673
Keywords
acute HVPG response; carvedilol; portal pressure; propranolol; randomized trial
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Funding
- Jacob & OlgaMadsen's Foundation
- Roche
- Research Foundation of Copenhagen Council
- Hvidovre Hospital Foundation for Liver Disease
- L.F. Foghts Foundation
- DPHG
- Novo Nordisk Foundation
- Novo Nordisk Fonden [NNF11OC1014467, NNF11OC1015075, NNF10OC1013267] Funding Source: researchfish
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Objectives. Carvedilol is a non-selective beta-blocker with intrinsic anti-alpha(1)-adrenergic activity, potentially more effective than propranolol in reducing hepatic venous pressure gradient (HVPG). We compared the long-term effect of carvedilol and propranolol on HVPG and assessed whether the acute response to oral propranolol predicted the long-term HVPG response on either drug. Material and methods. HVPG was measured in 38 patients with cirrhosis and HVPG >= 12 mm Hg at baseline and then again 90 min after an oral dose of 80 mg propranolol. Patients were double-blinded randomized to either carvedilol (21 patients) or propranolol (17 patients) and after 90 days of treatment HVPG measurements were repeated. Results. HVPG decreased by 19.3 +/- 16.1% (p < 0.01) and by 12.5 +/- 16.7% (p < 0.01) in the carvedilol and propranolol groups, respectively, with no significant difference between treatment regimens (p = 0.21). Although insignificant, an acute decrease in HVPG of >= 12% was the best cut-off value to predict long-term HVPG response to propranolol when using ROC curve analysis. Conclusions. This randomized study showed that carvedilol is at least as effective as propranolol on HVPG after long-term administration. Furthermore, a predictive value of an acute propranolol test on HVPG could not be confirmed.
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