Is it time to replace propranolol with carvedilol for portalhypertension？

• 作者: Anam Akbar Waheed. Muhammad Asif Baig Saadat Ali Shahab Abid
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: PORTAL HYPERTENSION Chronic liver disease Non-selective BETA-BLOCKERS PROPRANOLOL CARVEDILOL
• 年，卷（期）: 2015,（5）
• 页码范围: 532-539
• 页数: 8页
• 分类号: R

摘要

Beta-adrenergic receptor antagonists （β-blockers） havebeen well established for use in portal hypertensionfor more than three decades. Different Non-selectiveβ-blockers like propranolol, nadolol, timolol, atenolol,metoprolol and carvedilol have been in clinical practicein patients with cirrhosis. Carvedilol has proven 2-4times more potent than propranolol as a beta-receptorblocker in trials conducted testing its efficacy forheart failure. Whether the same effect extends to itspotency in the reduction of portal venous pressuresis a topic of on-going debate. The aim of this reviewis to compare the hemodynamic and clinical effectsof carvedilol with propranolol, and attempt assesswhether carvedilol can be used instead of propranolol inpatients with cirrhosis. Carvedilol is a promising agentamong the beta blockers of recent time that has shownsignificant effects in portal hypertension hemodynamics.It has also demonstrated an effective profile in itsclinical application specifically for the prevention ofvariceal bleeding. Carvedilol has more potent desiredphysiological effects when compared to Propranolol.However, it is uncertain at the present juncture whetherthe improvement in hemodynamics also translates into adecreased rate of disease progression and complicationswhen compared to propranolol. Currently Carvedilolshows promise as a therapy for portal hypertension butmore clinical trials need to be carried out before we canconsider it as a superior option and a replacement forpropranolol.