Document Detail

Acute administration of carvedilol is more effective than propranolol plus isosorbide-5-mononitrate in the reduction of portal pressure in patients with viral cirrhosis.
MedLine Citation:
PMID:  15447755     Owner:  NLM     Status:  MEDLINE    
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.
Han-Chieh Lin; Ying-Ying Yang; Ming-Chih Hou; Yi-Tsau Huang; Fa-Yauh Lee; Shou-Dong Lee
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  99     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-27     Completed Date:  2004-12-02     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1953-8     Citation Subset:  IM    
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Sec. 2 Shih-Pai Road, Taipei 11217, Taiwan.
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MeSH Terms
Antihypertensive Agents / administration & dosage*
Carbazoles / administration & dosage*
Drug Therapy, Combination
Hypertension, Portal / drug therapy*,  etiology
Isosorbide Dinitrate / administration & dosage*,  analogs & derivatives*
Liver Cirrhosis / complications*,  virology
Middle Aged
Propanolamines / administration & dosage*
Propranolol / administration & dosage*
Vasodilator Agents / administration & dosage*
Reg. No./Substance:
0/Antihypertensive Agents; 0/Carbazoles; 0/Propanolamines; 0/Vasodilator Agents; 0K47UL67F2/carvedilol; 16051-77-7/isosorbide-5-mononitrate; 525-66-6/Propranolol; 87-33-2/Isosorbide Dinitrate

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