Acute and chronic haemodynamic and renal effects of carvedilol in patientswith cirrhosis

Background/Aims: Recent reports have suggested that the vasodilating beta-b locker carvedilol may have beneficial acute haemodynamic effects in cirrhot ic portal hypertension, However, no data exist on chronic use or renal effe cts in this patient group. The aim of this study was to assess the acute an d chronic haemodynamic and renal effects of carvedilol in cirrhotic patient s. Methods: Seventeen cirrhotic patients (mean age 55.2+/-2.8, mean Child-Pugh score 7.4+/-0.5) were studied, Hepatic venous pressure gradient, cardiac o utput, systemic vascular resistance, mean arterial pressure, heart rate and hepatic blood flow were measured before and 1 h after 25 mg carvedilol, Af ter 4 weeks of therapy with carvedilol 25 mg daily, these measurements were repeated before and after rechallenge with carvedilol. Urine volume, sodiu m excretion and creatinine clearance were also measured before and after 4 creeks of therapy. Results: Seven patients did not complete the 4-week carvedilol therapy due to hypotension or poor compliance, Hepatic venous pressure gradient fell by 20.8% acutely (p<0.001) and by 16.3% after 4 weeks of therapy (p<0.002). H eart rate, mean arterial pressure and cardiac output fell after acute admin istration of carvedilol, but only heart rate fell significantly after 4 wee ks of treatment. Hepatic blood flow urine volume, sodium excretion and crea tinine clearance remained unchanged after therapy. Conclusion: Carvedilol has beneficial effects on splanchnic haemodynamics f ollowing acute and chronic administration in cirrhosis, without compromisin g hepatic blood flow or renal function. However, a substantial number of pa tients cannot tolerate 25 mg daily.