• Ruixuan Chen, Shiyu Zhou, Jiao Liu, Lu Li, Licong Su, Yanqin Li, Chuyao Fang, Xiaodong Zhang, Fan Luo, Qi Gao, Yuxin Lin, Zhixin Guo, Lisha Cao, Xin Xu, and Sheng Nie.
• State Key Laboratory of Organ Failure Research (Chen, Zhou, Liu, Su, Y. Li, Zhang, Luo, Gao, Lin, Guo, Cao, Xu, Nie), National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Oncology, Nanfang Hospital (L. Li, Fang), Southern Medical University, Guangzhou, Guangdong, China.
• CMAJ. 2024 Aug 11; 196 (27): E931E939E931-E939.

BackgroundHepatitis B virus (HBV) infection is a common cause of liver-related morbidity and mortality. Evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) decrease liver fibrosis, an intermediate step between liver injury and hepatocellular carcinoma (HCC). Our aim was to investigate the association between the use of ACEIs and ARBs on incident HCC and liver-related mortality among patients with HBV infection.MethodsWe conducted a population-based study on a new-user cohort of patients seen at 24 hospitals across China. We included adult patients with HBV infection who started ACEIs or ARBs (ACEIs/ARBs), or calcium channel blockers or thiazide diuretics (CCBs/THZs) from January 2012 to December 2022. The primary outcome was incident HCC; secondary outcomes were liver-related mortality and new-onset cirrhosis. We used propensity score matching and Cox proportional hazards regression to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of study outcomes.ResultsAmong 32 692 eligible patients (median age 58 [interquartile range (IQR) 48-68] yr, and 18 804 male [57.5%]), we matched 9946 pairs of patients starting ACEIs/ARBs or CCBs/THZs. During a mean follow-up of 2.3 years, the incidence rate of HCC per 1000 person-years was 4.11 and 5.94 among patients who started ACEIs/ARBs and CCBs/THZs, respectively, in the matched cohort. Use of ACEIs/ARBs was associated with lower risks of incident HCC (HR 0.66, 95% CI 0.50-0.86), liver-related mortality (HR 0.77, 95% CI 0.64-0.93), and new-onset cirrhosis (HR 0.81, 95% CI 0.70-0.94).InterpretationIn this cohort of patients with HBV infection, new users of ACEIs/ARBs had a lower risk of incident HCC, liver-related mortality, and new-onset cirrhosis than new users of CCBs/THZs.© 2024 CMA Impact Inc. or its licensors.

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