Background Carvedilol, a non‐selective beta‐ and α‐1 blocking agent, has portal hypotensive action. This study evaluates the acute and 7‐day response to carvedilol, and compares it to that of propranolol.

Methods Thirty‐six cirrhotics were randomized into two groups of 18 each, and treated with carvedilol or propranolol. Hepatic venous pressure gradient (HVPG) was measured before and 90 min after either 25 mg carvedilol or 80 mg propranolol was administered orally, and again 7 days after 12.5 mg carvedilol daily or 80 mg propranolol daily, respectively. ‘Responders’ were defined as those with HVPG reduction of ≥ 20%.

Results With carvedilol, 11/18(61.1%) and 11/17(64.7%) patients responded acutely and after 7 days, respectively, while 9/18(50%) and 10/16(62.5%) did so to propranolol. However, HVPG reduction (percent) by carvedilol was not superior to that by propranolol either acutely (27.67 ± 31.49 compared to 22.98 ± 27.40, P = 0.6) or after 7 days (28.2 ± 29.05 compared to 23.25 ± 20.15, P = 0.6). With carvedilol, the acute HVPG response (P < 0.001) and responder status (P = 0.018) were good predictors of the response after 7 days, but were weak predictors in the case of propranolol (0.1 > P > 0.05 and P = 0.059, respectively). On carvedilol, only one patient (with ascites) developed symptomatic systemic hypotension with oliguria.

Conclusion Carvedilol is a relatively safe, effective portal hypotensive agent, both acutely and over 7 days, but not superior to propranolol, at least in Indians. The acute hemodynamic response seems promising in predicting long‐term response.