The role of carvedilol in the management of portal hypertension

Tripathi, Dhiraj; Hayes, Peter

doi:10.1097/meg.0b013e3283367a99

Cited by 40 publications

(25 citation statements)

References 37 publications

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“…Carvedilol may be the optimal choice for beta-blockade in patients with ESLD. It has been demonstrated to cause a reduction in portal pressure through decreased splanchnic blood flow and decreased portocollateral resistance (66,67). Carvedilol has also been shown to be superior to other beta-blocking agents in reducing the hepatic venous pressure gradient (66,68).…”

Section: Pre-operative Cardiovascular Assessment and Managementmentioning

confidence: 98%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

229

174

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Liver transplantation (LT) candidates today are increasingly older, have greater medical acuity, and have more cardiovascular comorbidities than ever before. Steadily rising model for end-stage liver disease (MELD) scores at the time of transplant, resulting from high organ demand, reflect the escalating risk profiles of LT candidates. In addition to advanced age and the presence of comorbidities, there are specific cardiovascular responses in cirrhosis that can be detrimental to the LT candidate. Patients with cirrhosis requiring LT usually demonstrate increased cardiac output and a compromised ventricular response to stress, a condition termed cirrhotic cardiomyopathy. These cardiac disturbances are likely mediated by decreased beta-agonist transduction, increased circulating inflammatory mediators with cardiodepressant properties, and repolarization changes. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. These physiologic changes all contribute to the potential for cardiovascular complications, particularly with the altered hemodynamic stresses that LT patients face in the immediate post-operative period. Post-transplant reperfusion may result in cardiac death due to a multitude of causes, including arrhythmia, acute heart failure, and myocardial infarction. Recognizing the hemodynamic challenges encountered by LT patients in the perioperative period and how these responses can be exacerbated by underlying cardiac pathology is critical in developing recommendations for the pre-operative risk assessment and management of these patients. The following provides a review of the cardiovascular challenges in LT candidates, as well as evidence-based recommendations for their evaluation and management.

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Section: Pre-operative Cardiovascular Assessment and Managementmentioning

confidence: 98%

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Raval

Harinstein

Skaro

et al. 2011

Journal of the American College of Cardiology

229

174

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“…This may further enhance its effects on portal hypertension by reducing intrahepatic resistance. In hemodynamic clinical studies, carvedilol reduced portal pressure to a greater degree than propranolol [51]. The doses of propranolol or nadolol were modified to achieve a reduction in heart rate of 20-25% of baseline [41][42][43][44][46][47][48][49][50], or to maintain a systolic blood pressure of more than 100 mmHg and pulse of more than 50 bpm in one trial [45].…”

Section: Endoscopic Therapymentioning

confidence: 99%

Overview of the methods and therapies for the primary prevention of variceal bleeding

Tripathi

2010

Expert Review of Gastroenterology & Hepatology

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Patients with cirrhosis develop varices at a rate of 5% per year, and a third of patients with high-risk varices will bleed. The mortality associated with variceal haemorrhage is typically 20%, and still exceeds that of myocardial infarction. Current options to prevent the first variceal bleed include noncardioselective beta-blockers or variceal band ligation. In patients with medium-to-large esophageal varices, both therapies reduce the risk of bleeding by 50% or more. The choice of therapy should take into account patient choice and local availability; although for most patients drug therapy is the preferred first-line treatment. There has been recent interest in carvedilol, with promising initial data. Further studies are necessary before universal recommendation. There is no role for drug therapy in patients without varices, and the use of beta-blockers for patients with small varices is controversial.

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“…Nadolol, propranolol, and carvedilol have the most proven efficacy of lowering portal HTN and decreasing variceal bleeding episodes. 75,76 Nadolol is recommended in the management of portal HTN because of longer half-life and renal metabolism.…”

Section: B-adrenergic Blockersmentioning

confidence: 99%

Approach to Antihypertensive Therapy

Reddy

Dupree

2016

American Journal of Therapeutics

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Antihypertensive agents are commonly prescribed by physicians to prevent the long-term mortality from chronic hypertension. They are also given to improve survival in a number of conditions (eg, heart failure, coronary artery disease), independent of the effect on blood pressure. Several classes of antihypertensives are available with unique pharmacologic characteristics and adverse effects. Not all agents in the same class have identical effects, and careful selection of drugs based on the comorbid conditions is recommended.

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The role of carvedilol in the management of portal hypertension

Cited by 40 publications

References 37 publications

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Cardiovascular Risk Assessment of the Liver Transplant Candidate

Overview of the methods and therapies for the primary prevention of variceal bleeding

Approach to Antihypertensive Therapy

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