Abid Shahab, Ali Saadat, Baig Muhammad Asif, Waheed Anam Akbar
Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
World J Gastrointest Endosc. 2015 May 16;7(5):532-9. doi: 10.4253/wjge.v7.i5.532.
Beta-adrenergic receptor antagonists (β-blockers) have been well established for use in portal hypertension for more than three decades. Different Non-selective β-blockers like propranolol, nadolol, timolol, atenolol, metoprolol and carvedilol have been in clinical practice in patients with cirrhosis. Carvedilol has proven 2-4 times more potent than propranolol as a beta-receptor blocker in trials conducted testing its efficacy for heart failure. Whether the same effect extends to its potency in the reduction of portal venous pressures is a topic of on-going debate. The aim of this review is to compare the hemodynamic and clinical effects of carvedilol with propranolol, and attempt assess whether carvedilol can be used instead of propranolol in patients with cirrhosis. Carvedilol is a promising agent among the beta blockers of recent time that has shown significant effects in portal hypertension hemodynamics. It has also demonstrated an effective profile in its clinical application specifically for the prevention of variceal bleeding. Carvedilol has more potent desired physiological effects when compared to Propranolol. However, it is uncertain at the present juncture whether the improvement in hemodynamics also translates into a decreased rate of disease progression and complications when compared to propranolol. Currently Carvedilol shows promise as a therapy for portal hypertension but more clinical trials need to be carried out before we can consider it as a superior option and a replacement for propranolol.
β-肾上腺素能受体拮抗剂（β受体阻滞剂）已在门静脉高压症治疗中应用了三十多年。不同的非选择性β受体阻滞剂，如普萘洛尔、纳多洛尔、噻吗洛尔、阿替洛尔、美托洛尔和卡维地洛，已在肝硬化患者的临床实践中使用。在测试其对心力衰竭疗效的试验中，卡维地洛作为β受体阻滞剂的效力已被证明比普萘洛尔强2至4倍。其在降低门静脉压力方面是否同样有效，仍是一个持续争论的话题。本综述的目的是比较卡维地洛与普萘洛尔的血流动力学和临床效果，并试图评估卡维地洛是否可用于替代肝硬化患者中的普萘洛尔。卡维地洛是近年来β受体阻滞剂中一种有前景的药物，已在门静脉高压血流动力学方面显示出显著效果。它在临床应用中，特别是在预防静脉曲张出血方面，也展现出了有效的表现。与普萘洛尔相比，卡维地洛具有更强的预期生理效应。然而，目前尚不确定与普萘洛尔相比，血流动力学的改善是否也能转化为疾病进展率和并发症的降低。目前，卡维地洛作为门静脉高压症的一种治疗方法显示出了前景，但在我们将其视为优于普萘洛尔的选择并替代普萘洛尔之前，还需要进行更多的临床试验。
