| The role of carvedilol in the management of portal hypertension. | |
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MedLine Citation:
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PMID: 20093937 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Carvedilol is a potent noncardioselective beta-blocker, with weak vasodilating properties because of alpha 1 blockade. A reduction in both intrahepatic and portocollateral resistance contribute to enhanced effects on portal pressure. There are 10 published hemodynamic studies involving 168 patients investigating the role of carvedilol in portal hypertension. A reduction in the hepatic venous pressure gradient of up to 43% (range 10-43%) has been reported, particularly after chronic administration. However, tolerability at doses greater than 12.5 mg/day was comprised because of a fall in mean arterial pressure (MAP), particularly in ascitic patients. Carvedilol was more effective than propranolol in reducing hepatic venous pressure gradient in two of three studies, albeit with a greater decrease in MAP. One study showed deterioration of pre-existing ascites with carvedilol. The addition of nitrates to propranolol was less effective than carvedilol monotherapy in another study. A large multicentre, randomized controlled trial comparing carvedilol with variceal band ligation for the prevention of variceal bleeding has been published. Carvedilol resulted in fewer episodes of bleeding, although there was no difference in survival. Carvedilol was well tolerated. Carvedilol is a promising agent, and seems to be more effective than propranolol in hemodynamic studies. The efficacy in primary prevention of variceal bleeding suggests that carvedilol has a role in the management of clinically significant portal hypertension. |
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Authors:
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Dhiraj Tripathi; Peter C Hayes |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: European journal of gastroenterology & hepatology Volume: 22 ISSN: 1473-5687 ISO Abbreviation: Eur J Gastroenterol Hepatol Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-15 Completed Date: 2010-11-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9000874 Medline TA: Eur J Gastroenterol Hepatol Country: England |
Other Details:
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Languages: eng Pagination: 905-11 Citation Subset: IM |
Affiliation:
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Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. d.tripathi@bham.ac.uk |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antihypertensive Agents
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adverse effects,
therapeutic use* Ascites / drug therapy Benzopyrans / adverse effects, pharmacology, therapeutic use Carbazoles / adverse effects, pharmacology, therapeutic use* Drug Therapy, Combination / adverse effects Ethanolamines / adverse effects, pharmacology, therapeutic use Hemodynamics / drug effects Humans Hypertension, Portal / drug therapy* Multicenter Studies as Topic Nitrates / therapeutic use Propanolamines / adverse effects, pharmacology, therapeutic use* Propranolol / adverse effects, therapeutic use Randomized Controlled Trials as Topic |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Benzopyrans; 0/Carbazoles; 0/Ethanolamines; 0/Nitrates; 0/Propanolamines; 525-66-6/Propranolol; 72956-09-3/carvedilol; 99200-09-6/nebivolol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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