Associations of RAS inhibitors and Calcium Channel Blockers with Liver Stiffness Dynamics and Long-term Liver-Related Events in MASLD.

BACKGROUND

Hypertension is common in metabolic dysfunction-associated steatotic liver disease (MASLD), but the effects of specific antihypertensive drug classes on liver stiffness and liver-related events (LREs) remain unclear.

AIMS: We evaluated associations of renin-angiotensin system inhibitors (RASi) and calcium channel blockers (CCBs) with changes in liver stiffness and with long-term LRE risk.

DESIGN

We analyzed data from the VCTE-Prognosis cohort, an international multicenter study with serial liver stiffness measurements. Outcomes included liver stiffness progression (≥20% increase and Baveno category upshift), liver stiffness regression (≥20% decrease and Baveno category downshift), and incident LREs. We assessed associations between baseline antihypertensive therapy and liver outcomes using Cox proportional hazards models with inverse probability of treatment weighting, comparing RASi users versus non-users and CCB users versus non-users.

RESULTS

We followed 4,302 individuals with MASLD and hypertension for a median of 4.6 years, of whom 41.2% received RASi and 32.0% received CCBs. RASi use was associated with a higher likelihood of liver stiffness regression (HR=1.220, 95%CI 1.010-1.474; P=0.039) and associated with a lower risk of long-term LREs (HR=0.431, 95%CI 0.261-0.714; P=0.001), with no significant effect on liver stiffness progression. Conversely, CCB use was associated with a lower risk of liver stiffness progression (HR=0.681, 95%CI 0.521-0.890; P=0.005) and LREs (HR=0.559, 95%CI 0.326-0.958; P=0.034), but not with liver stiffness regression. Findings were consistent across subgroup and sensitivity analyses.

CONCLUSION

RASi and CCB use were associated with favorable liver stiffness trajectories and lower risk of long-term liver-related events in individuals with MASLD and hypertension.