The effects of angiotensin blocking agents on the progression of liver fibrosis in the HALT-C Trial cohort

Barham K. Abu Dayyeh, May Yang, Jules L. Dienstag, Raymond T. Chung

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Background: Therapies that can slow the progression of liver fibrosis in chronic liver disease are needed. Evidence suggests that the renin-angiotensin system (RAS) contributes to inflammation and fibrosis in chronic liver disease. Both animal and limited human studies have shown that RAS inhibition with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor-1 [AT-1] blockers (ARBs) has antifibrogenic properties. Aims: In this study, we evaluated the effects of continuous ACEi/ARB use for 3.5 years on histological liver fibrosis progression in the HALT-C Trial cohort. Methods: In the HALT-C Trial, subjects with chronic hepatitis C and advanced hepatic fibrosis (Ishak stage ≤3) underwent serial liver biopsies at baseline, 1.5 years, and 3.5 years after randomization. The primary outcome was a ≤2-point increase in Ishak fibrosis score in at least one of the two serial biopsies. Sixty-six subjects were continuously taking ACEi/ARBs over the observation period, 126 were taking other antihypertensive medications, and 343 subjects took no antihypertensive medications. Results: The three groups were similar in baseline fibrosis scores, and the two groups being treated with antihypertensives were taking a similar number of antihypertensive medications. Fibrosis progression occurred in 33.3% of the ACEi/ARB group, 32.5% of the other antihypertensive medications group, and in 25.7% of subjects taking no antihypertensive medications. No significant associations between ≤2-point increases in fibrosis scores and continuous ACEi/ARB use were apparent at either 1.5 or 3.5 years in diabetes-adjusted and unadjusted odds ratios. Conclusions: ACEi/ARB therapy did not retard the progression of hepatic fibrosis.

Original languageEnglish (US)
Pages (from-to)564-568
Number of pages5
JournalDigestive diseases and sciences
Volume56
Issue number2
DOIs
StatePublished - Feb 2011

Keywords

  • ACE inhibitors
  • Angiotensin receptor blockers
  • Diabetes
  • Hypertension
  • Liver fibrosis
  • Renin-angiotensin system

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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