Abstract: Objective To assess the prophylactic effect of carvedilol and propranolol for first esophageal and gastric variceal bleeding in cirrhotic patients. Methods A total of 125 patients with liver cirrhosis and esophageal and gastric varices were randomly divided into carvedilol-intervened group（n=61） and propranolol-intervened group（n=64）,receiving carvedilol and propranolol respectively for prophylaxis of gastrointestinal bleeding. The first variceal bleeding,biochemical index,hepatic vein pressure gradient（HVPG） and side effect were compared between the two groups. Results The clinical data such as gender,age,Child-Pugh class and complications of ascites at presentation were not significantly different between the two group （P>0.05）;there were 18 patients （29.5%） having first esophageal and gastric variceal bleeding in carvedilol-intervened group, and there were 20 patients（31.3%） having first esophageal and gastric variceal bleeding in propranolol-treated group during the follow-up period,which showed no significant differences between the two groups（P>0.05）;the HVPG level in carvedilol-intervened group decreased significantly from （14.1±3.7） mmHg at presentation to （10.3±2.1） mmHg after treatment（P<0.05）,and the HVPG level in propranolol-treated group also decreased significantly from （14.6±4.3） mmHg to （12.0±2.3） mmHg （P<0.05） without significant difference between the two group（P>0.05）;the changes of serum ALT, bilirubin and creatinine levels between the two groups showed no significant differences（P>0.05）;there were 10 cases having dizziness,3 cases having syncope,4 cases having chest distress and 1 case having anhelation in carvedilol-intervened group,while there were 8,2,6 and 1 case,respectively,in the propranolol-treated group,suggesting no significant difference between the two groups as respect to the incidence of side effects （P>0.05）. Conclusions Both carvedilol and propranolol have good prophylactic effects for the first esophageal and gastric variceal bleeding in cirrhotic patients,which needs further investigation.