Hemodynamic Effect Of Carvedilol Compared With Propranolol For Portal Hypertension In Cirrhosis: A Systematic Review

ObjectiverTo evaluate the carvedilol and propranolol in the reduction of liver cirrhosis with portal hypertension is effective and safety.Methods:A computer search of Pubmed, Cochrane Library, EMbase, CNKI, CBM, WANFANG DATABASE and VIP to April 2015, to collect randomized controlled trials (RCTs) on the application of propranolol and carvedilol in the treatment of liver cirrhosis and portal hypertension. Study selection and assessment, data collection and analysis were undertaken. Meta-analyses were performed by RevMan 5.3 software.Result:Six RCTs involving 310 patients were included. Among them,4 articles in English,2 articles in Chinese. Propranolol treatment group (control group) 153 cases, carvedilol treatment group(experimental group) 157 cases. Based on the improved Jadad scale scores were higher than 4 point, belong to high quality articles.The meta analysis showed that:after single administration,the HVPG,FHVP,WHVP decreased more with carvedilol than with propranolol[WMD=-2.36,95%CI (-2.98,-1.75), P<0.00001]、[WMD=-0.70,95%CI (-1.38,-0.02), P=0.04]. [WMD=-2.99,95%CI (-3.88,-2.09), P<0.001]. There were no significant differences between two group in HVPG response rate,MAP and HR (P=0.38, P=0.07, P=0.55). After continued administration, carvedilol decreased the effect of HVPG,HVPG drop,HVPG response rate and WHVP is better than that of propranolol, the difference was statistically significant[WMD=-2.02,95%CI (-3.01,-1.04), P<0.001]、 [WMD=9.88,95%CI (5.82,13.94), P<0.001]、[OR=1.91,95%CI (1.18, 3.10), P=0.008]、[WMD=-1.33,95%CI (-2.67,0.01), P=0.05]. The HR after treatment is slower in ropranolol group than carvedilol group,with a statistical significance [WMD= 3.61,95%CI (1.91,5.31), P<0.0001]. There were no significant differences between two group in FHVP,MAP and HBF (P=0.28, P=0.14, P=0.06). Liver function score for Child-PughB/C class patients receiving carvedilol reduce HVPG is better than Child-PughA class patients with portal hypertension, the difference was statistically significant [WMD=-10.04,95% CI (-16.57,-3.51), P=0.003];NO such difference in the propranolol (P=0.52). In the occurrence of adverse events and effects on liver and kidney function during the comparison, the difference was no statistically significant.Conclution:Carvedilol reduced portal pressure in patients with liver cirrhosis than propranolol significantly, so that more patients achieved hemodynamic response. Carvedilol and propranolol were not aggravate the liver and kidney function damage, adverse events were similar, but the reliability is still need large sample clinical tests.