Acute 1-hour hepatic venous pressure gradient response to carvedilol and nebivolol predicts effect after 14-days treatment in patients with liver cirrhosis

Abstract

Introduction. Beta-blockers continue to be the first -line treatment for primary prevention of variceal hemorrhage. The addition of isosorbide mononitrate (with NO donation effect) appears to improve the effectiveness of beta-blockers; however it could cause increasing of side effects. Nebivolol is a new third generation beta1-receptor blocker that causes vasodilatation by evoking endothelial NO production. The effect of nebivolol on portal hypertension has never been tested. Aims&methods. The aim of an open, randomized study was to compare carvedilol and nebivolol effect on hepatic venous pressure gradient (NVPG) response in patients with liver cirrhosis. Twenty cirrhotic patients (pts) were randomized and treated with carvedilol (10pts) or nebivolol (10pts). HVPG was measured before and 60 min after, when either 25 mg carvedilol or 5 mg nebivolol was administered orally; and also 14 days after 25 mg carvedilol daily or 5 mg nebivolol daily, respectively. "Responders" were defined as those with HVPG reduction of ≥ 20%, or ≤ 12 mm Hg. Results. One patient within carvedilol group and two patients within nebivolol group dropped from the study after the acute probe due to side affects. [...].