ACEI use significantly reduced the risk of incident hepatocellular carcinoma compared to non-use in adults with chronic hepatitis B and hypertension (aHR 0.66; 95% CI 0.64-0.69).
Cohort (n=237,430)
Yes
Do angiotensin-converting enzyme inhibitors reduce the risk of incident hepatocellular carcinoma in adults with chronic hepatitis B and hypertension?
ACEI use is associated with a robust, dose-dependent reduction in hepatocellular carcinoma risk among patients with chronic hepatitis B and hypertension.
Effect estimate: aHR 0.66 (95% CI 0.64-0.69)
Background: Chronic hepatitis B virus (HBV) infection is a leading cause of hepatocellular carcinoma (HCC). Angiotensin-converting enzyme inhibitors (ACEIs) may reduce HCC risk by modulating hepatic fibrogenesis, but population-level evidence remains limited. Methods: We conducted a nationwide cohort study using Taiwan’s National Health Insurance Research Database (2010–2020), including adults with chronic HBV and hypertension. ACEI use was defined as ≥28 cumulative defined daily doses (cDDDs). We applied a new-user design, propensity score matching, time-varying Cox models, and competing risk analysis to assess incident HCC. Results: After 1:1 propensity score matching, 118,715 patients were included in each group. ACEI users had a significantly lower HCC risk than non-users (adjusted hazard ratio aHR, 0.66; 95% CI, 0.64–0.69). A strong dose-dependent effect was observed, with the highest cDDD quartile demonstrating the greatest risk reduction (aHR, 0.29; 95% CI, 0.26–0.32). This protective association persisted regardless of concurrent nucleos(t)ide analogue (NA) therapy. Furthermore, treatment persistence (>1 year) was associated with lower HCC risk compared to early discontinuation (aHR, 0.62 vs. 0.71). Conclusions: ACEI use was associated with a robust, dose-dependent reduction in HCC risk among chronic HBV patients with hypertension. These findings highlight the translational potential of repurposing ACEIs for HCC chemoprevention, particularly for hypertensive HBV carriers currently ineligible for antiviral therapy.
Yu et al. (Fri,) conducted a cohort in Chronic hepatitis B and hypertension (n=237,430). Angiotensin-converting enzyme inhibitors (ACEIs) vs. Non-users was evaluated on Incident hepatocellular carcinoma (HCC) (aHR 0.66, 95% CI 0.64-0.69). ACEI use significantly reduced the risk of incident hepatocellular carcinoma compared to non-use in adults with chronic hepatitis B and hypertension (aHR 0.66; 95% CI 0.64-0.69).