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Volume 2, Issue 2 (Suppl) Chronic Obstructive Pulmonary Diseases
ISSN: 2572-5548
Page 50
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CO-ORGANIZED EVENT
August 31-September 01, 2017 Brussels, Belgium
&
International Conference on Chronic Diseases
6th International Conference on Microbial Physiology and Genomics
The efficacy of carvedilol vs. propranolol in decreasing portal hypertension among cirrhotic patients
- Ameta-analysis
Higinio T Mappala and D K Gurung
Jose Reyes Memorial Medical Center, Philippines
Background: Despite advances in management of acute variceal bleeding, the hospital mortality of cirrhotic patients remains
as high as 20%. It has been established that hemodynamic response to drug treatments either with propranolol or nadolol alone
or with a beta-blocker in combination of propranolol and nitrates. A decrease in hepatic venous pressure gradient (HPVG)
to 12 mm HG or 20% is of clinical significance in reducing complications related to liver cirrhosis. Mortality increases when
portal hypertension is not addressed therapeutically.
Aim: Aim of this study is to compare the hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients in reducing
portal hypertension measured in terms of hepatic venous pressure gradient.
Materials & Methods: Meta-analysis and randomized control trials were extracted from different sources, from PubMed,
Embase, Cochrane Library, Google, and Science Citation Index (ISI Web of Science), BMJ , Best practice, Cochrane, GastroHep,
Medscape, and other web sources, comparing carvedilol and propranolol in cirrhotic patients. 14 articles were searched and
reviewed and after exclusion, four articles with a total of 28 patients were included, whose primary outcome is a hemodynamic
response, a decrease in hepatic venous pressure gradient (HVPG) induced by the respective drugs. Patients (N=38) received
carvedilol (N=21) at a dose range of 6.5 to 50 mg per day and propranolol dose at 10 mg-320 mg per day.
Results: The forest plot showed results in favor of carvedilol, which reduced HVPG by 19% compared to propranolol, which
reduced HPVG by 12% from baseline (p value=0.0004).
Conclusion: Themeta-analysis shows that carvedilol is superior to propranolol in decreasingHVPG - 19% and 12% respectively
(p value of 0.0004). This may have significant clinical implications in terms of reducing complications due to liver cirrhosis, like
variceal bleeding in portal hypertensive patients.
Biography
Higinio Mappala is currently working as an Associate Professor at Department of Internal Medicine-Gastroenterology-Clinical Nutrition-Clinical Toxicology, Jose
Reyes Memorial Medical Center in Philippines. He graduated at University of Santo Tomas (UST), College of Medicine. He is the member of Hepatology Society
of the Philippines and Philippine Society of Enteral/Parenteral Nutrition. He has published numerous research papers and articles in reputed journals and has
extended his valuable service towards the scientific community with his extensive research work.
Higinio T Mappala et al., Chron Obstruct Pulmon Dis 2017, 2:2
DOI: 10.21767/2572-5548-C1-003