Comparison of Carvedilol to Propranolol in Reduction of Hepatic Venous Pressure Gradient in Liver Cirrhosis: A Meta-Analysis.

BACKGROUND

Nonselective beta-blockers, such as propranolol and carvedilol, are used to prevent first decompensation in patients with clinically significant portal hypertension.

METHODS

We performed a systematic literature search of English language articles from inception in PubMed, Medline, and Cochrane databases to compare the effect of carvedilol and propranolol on systemic and splanchnic hemodynamics. Mean differences were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant.

RESULTS

Seven RCTs with a total of 351 patients were involved in the final analysis. Reduction in hepatic venous pressure gradient was significantly greater in the carvedilol group (MD = -0.76, 95% CI = -1.45 to -0.08; p = 0.03). Decrease in systemic vascular resistance and mean arterial pressure was significantly greater in the carvedilol group ([MD = -190.55, 95% CI = -307.5 to -73.58; p = 0.001] and [MD = -3.65, 95% CI = -5.94 to -1.36; p = 0.002], respectively). Decrease in cardiac output was greater in the propranolol group (MD = 0.92, 95% CI = 0.45-1.38; p = 0.004). Decrease in hepatic blood flow and right atrial pressure appeared to be greater in the propranolol group; however, this did not reach statistical significance ([MD = 0.13, 95% CI = -0.06 to 0.32; p = 0.17] and [MD = 0.28, 95% CI = -0.27 to 0.83; p = 0.32], respectively). Decrease in mean pulmonary arterial pressure appeared to be greater in the carvedilol group; however, this was not statistically significant (MD = -0.75, 95% CI = -1.60 to 0.10; p = 0.08). There was no difference in incidence of rebleeding, shortness of breath, hepatic encephalopathy, and hypotension between the two groups.

CONCLUSION

Carvedilol demonstrated a significantly greater reduction in HVPG, SVR, and MAP compared to propranolol, with no significant difference in adverse effects.