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A recent meta-analysis demonstrated that carvedilol, a nonselective beta-blocker with additional anti–alpha-adrenergic activity, is more effective than propranolol in reducing portal pressure in patients with varices. However, few of the trials included in the meta-analysis incorporated hepatic venous pressure gradient (HVPG) measurements.
In the current open-label study, researchers compared hemodynamic response (a ≥20 decrease in HVPG from baseline or HVPG <12 mm Hg) in 110 patients randomized to carvedilol or propranolol. Patients had cirrhosis, severe portal hypertension (HVPG >12 mm Hg), and grade 2 or 3 esophageal varices on endoscopy with or without a history of esophageal variceal hemorrhage. Drugs were titrated up to achieve a targe…