Background: There are controversial results available about using angiotensin-converting enzyme
inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) and the development of cancers or improvement of
clinical outcomes. Studies reported that using ACEI/ARB may enhance the development of hepatocellular carcinoma
(HCC) and clinical outcomes.
Objective: This meta-analysis aimed to assess the relationship between ACEI/ARB therapy and the development
Methods: PubMed, EMBASE and the Cochrane library were reviewed to identify clinical studies investigating
the association between ACEI/ARB therapy and the risk of HCC development. The pooled risk ratio (RR) with
95% confidence intervals collected for the association between using ACEIs/ARBs and HCC development.
Results: Patients with HCC benefit from the treatment with both ACEIs and ARBs (RR 0.704, 95% CI 0.526-
0.944, p = 0.019). However, only using ARBs was related to HCC risk (0.545 95% CI 0.470-0.632, P<0.0001).
Moreover, the study types were significantly related to the observed effects of using both ARBs and ACEIs. Only
cohort studies were significantly related to achieving better results (RR=0.513, 95% CI= 0.442-0.597, P<0.0001).
Conclusion: Despite the small number and heterogeneity of the studies evaluating the relationship between
treatment with ARBs and ACEIs and the development of HCC, our meta-analysis demonstrates that they may
reduce the risk of HCC.