ACE-I/ARB use helps avert death in cirrhosis patients

Exposure to angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) may prevent mortality among patients with cirrhosis, a study has shown.

Additionally, ACE-I and ARB do not appear to contribute to hepatic decompensation or hepatocellular carcinoma (HCC) among patients with compensated disease.

Patients with cirrhosis in the Veterans Health Administration were included in this retrospective, active comparator new use study. The investigators identified initiators of ACE-I/ARB or calcium channel blockers (CCB; comparators).

The association between ACE-I/ARB and outcomes of mortality, cirrhosis decompensation, and HCC was explored using inverse probability treatment weighting balanced key confounders and Cox regression. The investigators also performed an exploratory analysis via cause-specific competing risk models to assess liver-related vs cardiovascular (CV)-related vs nonliver/non-CV‒related deaths.

A total of 904 ACE-I/ARB and 352 CCB new initiators were included. ACE-I/ARB exposure correlated with reduced mortality (hazard ratio [HR], 0.70, 95 percent confidence interval [CI], 0.61‒0.81; p<0.001). In patients with compensated cirrhosis, ACE-I/ARB showed no significant association with hepatic decompensation or HCC.

In addition, ACE-I/ARB exposure resulted in a decrease in nonliver/non-CV‒related mortality (cause-specific HR, 0.49, 95 percent CI, 0.38‒0.62; p<0.001), but not liver-related or CV-related deaths. In Child-Turcotte-Pugh A patients, the use of ACE-I/ARB appeared to reduce CV-related deaths (cause-specific HR, 0.41, 95 percent CI, 0.26‒0.65; p<0.001).

“Future research should identify subsets of patients who benefit from ACE-I/ARB exposure,” the investigators said.