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.