The effect of carvedilol and propranolol on portal hypertension in patients with cirrhosis: a meta-analysis

Abstract

Sheng Chen,1,* Jin-Jun Wang,2,* Qin-Qin Wang,1 Jun-Wei Hu,1 Shuang Dong,1 Li-Juan Hu,1 Yi-Cheng Jian,1 Xin-Yan Liu,2 Gen-Mei Yang,2 Wu-Jun Xiong1 1Department of Hepatology, Tongji University School of Medicine, Shanghai East Hospital, 2Department of Gerontology, Shanghai Traditional Chinese Medicine University, Shanghai Putuo Central Hospital, Shanghai, People’s Republic of China *These authors contributed equally to this workPurpose: Several randomized controlled clinical trials have been conducted to investigate the role of carvedilol and propranolol on the effect of portal pressure in patients with cirrhosis, leading to controversial results. Current meta-analysis was performed to compare the efficacy of the two drugs on portal pressure.Patients and methods: Two-hundred and ninety eligible patients were recruited. Published studies were selected based on PubMed, the Cochrane Library, Chinese Journal Full-text Database, and Wanfang Database. The outcome measurements included the mean difference (MD) in the percentage of hepatic vein pressure gradient reduction (%HVPG reduction), the risk ratio (RR) of nonresponders in hemodynamic assessment, and the percentage of mean arterial pressure reduction (%MAP reduction). Subgroup analysis was performed.Results: Seven trials were identified (including five acute and three long-term drug administration randomized controlled trials). A summary of pooled MD between the %HVPG reduction is as follows: overall -8.62 (confidence interval [CI] -11.76, -5.48, P<0.00001), acute -10.05 (CI -14.24, -5.86, P<0.00001), and long term -6.80 (CI -11.53, -2.07, P=0.005), while summary of pooled RR of hemodynamic nonresponders with carvedilol was as follows: overall 0.64 (CI 0.51, 0.81, P=0.0002), acute 0.63 (CI 0.47, 0.85, P=0.002), and long term 0.67 (CI 0.47, 0.97, P=0.03). Both of the outcome measurements favored carvedilol. Significant heterogeneity (P<0.1, I2=92%) existed between the two treatment groups in %MAP reduction. No considerable difference could be observed in the %MAP reduction through the poor overlapping CI boundaries.Conclusion: Carvedilol has a greater portal hypertensive effect than propranolol. Further comparative trials of the two drugs are required to identify the effect of MAP reduction. Keywords: carvedilol, propranolol, portal hypertension, randomized controlled clinical trials, meta-analysis