COMPARATIVE EFFICACY OF CARVEDILOL VS. PROPRANOLOL IN MANAGING PORTAL HYPERTENSION AND ESOPHAGEAL VARICES IN LIVER CIRRHOSIS: OPTIMIZING THERAPEUTIC STRATEGIES FOR IMPROVED OUTCOMES

Abstract

Objective: This study aimed to compare carvedilol and propranolol in treating portal hypertension and esophageal varices in liver cirrhosis. It also assessed drug tolerance and the risk of bleeding complications. Methodology: This quasi-experimental study was conducted from April 2024 to May 2025 at two tertiary hospitals in Baluchistan. Ninety-eight cirrhotic patients with esophageal varices were non-randomly assigned to carvedilol or propranolol groups (49 each). HVPG was measured before and after six months of tsherapy. Patients were monitored for variceal bleeding, drug tolerance, and adverse events. Data were collected using a structured proforma and analyzed with SPSS v26 using chi-square and t-tests. Ethical approval and informed consent were obtained. Results: The mean age was 45.8±10.5 years (range: 25–65); 61(62%) were male and 37(38%) female. Mean weight, height, and BMI were 68.5±12.2 kg, 165.7±9.5 cm, and 24.8±3.6 kg/m². Cirrhosis duration averaged 5.2±3.8 years. Hepatitis C 54(55%) and hepatitis B 33(34%) were common causes. Variceal bleeding was found in 40(41%), and 29(29%) had prior band ligation. Mean ALT and AST were 62.8±22.4 and 78.1±26.3 U/L. Portal vein diameter reduced from 14.2±2.1 mm to 11.5±1.8 mm in the carvedilol group and 12.4±2.0 mm in the propranolol group. Most patients continued NSBB therapy; some required combination or advanced treatments. Conclusion: Carvedilol reduced portal pressure more than propranolol. It also showed fewer bleeding episodes and less need for rescue therapy. Carvedilol may be a better option in clinical settings.