Patients with metabolic dysfunction-associatedsteatotic liver disease (MASLD) and cirrhosis who are taking antihypertensive medications, including calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), are at increased risk of developing hepatocellular carcinoma (HCC), suggests a study. 

“We found that medications such as CCBs or ACEIs/ARBs used for treating high blood pressure (BP) were linked to 2.5 times higher risk of developing liver cancer compared to nonusers in the presence of MASLD and cirrhosis,” said presenting author Dr Ahmed Elhariri from the Section of Gastroenterology and Hepatology, Baylor College of Medicine in Houston, Texas, US. 

In this case-control study, Elhariri and his team recruited 153 newly diagnosed HCC patients with different aetiologies and 170 MASLD patients without HCC between September 2020 and April 2024. They then selected age- and sex-matched MASLD-induced HCC patients (n=47) and MASLD controls (n=47). Only those with a history of hypertension were included in the analysis. 

Elhariri and colleagues also obtained demographic characteristics and other risk factors of metabolic syndrome and HCC, including diabetes. They retrieved a detailed history of medication use, including metformin and statins, from physician and pharmacy notes. 

Descriptive statistics were carried out to compare cases (defined as MASLD-induced HCC diagnosed by histology or radiology) and controls (defined as MASLD patients without HCC). Finally, the investigators conducted a multivariable unconditional logistic regression analysis, adjusted for relevant confounders, to estimate the odds ratio (OR) and 95 percent confidence interval (CI) values. 

Of the eligible participants, 42 HCC patients (mean age 66.5 years) and 39 MASLD controls (mean age 63.5 years) had a history of hypertension and received antihypertensive medications. BMI was comparable between cases and controls (31.1 and 31.7 kg/m2, respectively). 

Compared to nonusers, CCB users showed a 2.7-fold higher risk of developing HCC, while ACEI/ARB users had a 2.5-fold increased risk. [AASLD 2024, abstract 2352] 

While the results seem alarming, the cardiovascular benefits derived from antihypertensive medications still outweigh the risk of liver cancer in patients with MASLD, according to Elhariri, noting the need for more data before raising any concern in the general population. 

“Although our study showed some association between the use of some commonly used antihypertensive medications, such as ACEIs/ARBs and CCBs, and the risk for HCC in the high-risk population with MASLD and cirrhosis, the study is based on data collected retrospectively on a small of patients,” he said. 

“We need to have a randomized control trial done prospectively with a larger sample size to explore the risk,” Elhariri added. 

In addition, the investigators stressed the need to have stricter surveillance for liver cancer among patients with MASLD and cirrhosis who are taking medications to treat high BP, as recommended by guidelines published by the society. 

“We need to carefully review BP medications in patients with MASLD and cirrhosis and possibly substitute CCBs and ACEIs/ARBs with beta-blockers that have been shown to reduce progression of cirrhosis-related complications,” Elhariri said.