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Published on: September 30, 2021

Angiotensin-Converting Enzyme Inhibitors and Hepatocellular Carcinoma Risk in Patients With Chronic Hepatitis B and

Jung-Min Yu1,2, Wan-Ming Chen3,4, Ming-Feng Chiang5

  • 1Department of Cardiovascular Surgery, Taichung Tzu Chi Hospital, Taichung, Taiwan.

Clinical and Translational Gastroenterology
|May 15, 2026
PubMed

Insights

Angiotensin-converting enzyme inhibitors (ACEIs) significantly reduced hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B (HBV) and hypertension. Higher ACEI doses and longer treatment duration correlated with greater risk reduction.

Area of Science:

  • Hepatology
  • Cardiovascular Pharmacology
  • Oncology

Background:

  • Chronic hepatitis B virus (HBV) infection is a primary driver of hepatocellular carcinoma (HCC).
  • Angiotensin-converting enzyme inhibitors (ACEIs) show potential in mitigating HCC risk by influencing hepatic fibrogenesis, but large-scale data are scarce.

Purpose of the Study:

  • To investigate the association between ACEI use and HCC incidence in a nationwide cohort of patients with chronic HBV and hypertension.
  • To evaluate the dose-response relationship and impact of treatment persistence on HCC risk reduction.

Main Methods:

  • A nationwide cohort study utilized Taiwan's National Health Insurance Research Database (2010-2020).
  • Propensity score matching and time-varying Cox models were employed to analyze incident HCC risk in adult chronic HBV patients with hypertension, defining ACEI use by cumulative defined daily doses (cDDDs).

Main Results:

  • After propensity score matching (n=118,715 per group), ACEI users exhibited significantly lower HCC risk (aHR, 0.66).
  • A pronounced dose-dependent effect was observed, with the highest ACEI cDDD quartile showing the greatest risk reduction (aHR, 0.29).
  • The protective association remained consistent irrespective of concurrent nucleos(t)ide analogue therapy and was stronger with treatment persistence (>1 year).

Conclusions:

  • ACEI use is linked to a substantial, dose-dependent decrease in HCC risk among hypertensive patients with chronic HBV.
  • Repurposing ACEIs offers a promising strategy for HCC chemoprevention, especially for HBV carriers with hypertension ineligible for antiviral treatments.
Abstract

Keywords:
ACE inhibitorschemopreventionhepatitis B virushepatocellular carcinomapopulation-based cohort study

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