Associations of Renin-Angiotensin System Inhibitors and Calcium Channel Blockers With Liver Stiffness Dynamics and Long-Term Liver-Related Events in Metabolic Dysfunction-Associated Steatotic Liver Disease

Zhou XD 1 , Chen QF 2 , Kim SU 3 , Cheuk-Fung Yip T 4 , Petta S 5 , Nakajima A 6 Show all authors , Tsochatzis E 7 , Boursier J 8 , Bugianesi E 9 , Shang Y 10 , Chan WK 11 , Romero-Gomez M 12 , Calleja JL 13 , de Lédinghen V 14 , Castéra L 15 , Sanyal AJ 16 , Boon-Bee Goh G 17 , Newsome PN 18 , Fan JG 19 , Lai M 20 , Fournier-Poizat C 14 , Lee HW 3 , Lai-Hung Wong G 4 , Armandi A 9 , Pennisi G 5 , Llop E 13 , Yoneda M 6 , Zoncapè M 7 , de Saint-Loup M 8 , Gallego-Durán R 12 , Carrillo-Fernández P 12 , Asgharpour A 16 , Kim-Jun Teh K 17 , Sau-Wai Chan M 14 , Lin H 21 , Liu WY 22 , Targher G 23 , Byrne CD 24 , Wai-Sun Wong V 25 , Zheng MH 26 , VCTE-Prognosis Study Group

Affiliations 

  • 1 Department of Hepatology, MAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 2 Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Institute of Aging, The Center for Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 3 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 4 Department of Medicine and Therapeutics, Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
  • 5 Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
  • 6 Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
  • 7 University College London (UCL) Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom; Liver Unit, Department of Internal Medicine, University and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
  • 8 Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France
  • 9 Division of Gastroenterology and Hepatology, Department of Medical Sciences, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
  • 10 Department of Medicine, Karolinska Institutet, Huddinge, Sweden
  • 11 Gastroenterology and Hepatology Unit, Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 12 UCM Digestive Diseases, Virgen del Rocío University Hospital, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Institute of Biomedicine of Seville (IBiS), University of Seville, Seville, Spain
  • 13 Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
  • 14 Echosens, Paris, France
  • 15 Université Paris Cité, UMR1149 (CRI), INSERM, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
  • 16 Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
  • 17 Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
  • 18 Faculty of Life Sciences and Medicine, Institute of Hepatology, King's College London and King's College Hospital, London, United Kingdom
  • 19 Department of Gastroenterology and Hepatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  • 20 Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 21 Department of Gastroenterology and Hepatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Center for Digestive Diseases Research and Clinical Translation of Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gut Microecology and Associated Major Diseases Research, Shanghai, China
  • 22 Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 23 Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy
  • 24 Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
  • 25 Department of Medicine and Therapeutics, Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: wongv@cuhk.edu.hk
  • 26 Department of Hepatology, MAFLD Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou, China; Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China. Electronic address: zhengmh@wmu.edu.cn
Clin Gastroenterol Hepatol, 2026 Oct 06.
PMID: 42838311 DOI: 10.1016/j.cgh.2026.09.041

Abstract

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

METHODS: 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 vs nonusers and CCB users vs nonusers.

RESULTS: We followed 4302 individuals with MASLD and hypertension for a median of 4.6 years, of whom 41.2% received RASis and 32.0% received CCBs. RASi use was associated with a higher likelihood of liver stiffness regression (hazard ratio [HR], 1.220; 95% confidence interval [CI], 1.010-1.474; P = .039) and associated with a lower risk of long-term LREs (HR, 0.431; 95% CI 0.261-0.714; P = .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 = .005) and LREs (HR, 0.559; 95% CI, 0.326-0.958; P = .034), but not with liver stiffness regression. Findings were consistent across subgroup and sensitivity analyses.

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

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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