{"id":"791d750696da","type":"article","url":"https://hartvaat.nl/2026/12/31/acei-s-en-arb-s-geassocieerd-met-lagere-sterfte-en-leverfibrose-bij-masld-nhanes/","title":"ACEI's en ARB's geassocieerd met lagere sterfte en leverfibrose bij MASLD — NHANES-analyse","title_en":"Associations of antihypertensive medication class with liver fibrosis and mortality in US adults with MASLD.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Clinical and experimental hypertension (New York, N.Y. : 1993)","doi":"10.1080/10641963.2026.2725928","source_url":"https://doi.org/10.1080/10641963.2026.2725928","authors":["Yu Wu","Fei Fang"],"significance":3,"published":"2026-09-14","source_date":"2026-12-31","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"An observational analysis of NHANES data (1999–2018) examined associations between antihypertensive classes and liver fibrosis or mortality in US adults with metabolic dysfunction-associated steatotic liver disease (MASLD). Monotherapy users of ACE inhibitors or ARBs showed significantly lower all-cause mortality compared with calcium channel blockers (adjusted HR 0.30 and 0.25) and reduced odds of liver fibrosis (adjusted OR 0.51). While these findings suggest a potential benefit of renin-angiotensin system blockers in MASLD, the authors caution that the results are hypothesis-generating and require validation in prospective cohorts.","created":"2026-09-08T00:46:46Z","updated":"2026-09-08T00:46:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve analyse van NHANES-gegevens (1999–2018) onderzocht de associatie tussen antihypertensiva en leverfibrose of sterfte bij volwassenen met MASLD. Gebruikers van ACEI's of ARB's hadden een aanzienlijk lager sterfterisico vergeleken met calciumantagonisten (aHR 0,30 en 0,25) en een lagere prevalentie van leverfibrose (aOR 0,51 voor FIB-4). Hoewel de bevindingen klinisch interessant zijn voor het kiezen van een antihypertensivum bij metabole leverziekte, benadrukken de auteurs dat het om hypothese-genererend onderzoek gaat dat bevestiging in prospectieve studies vereist.","abstract_original":"OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexists with hypertension, yet comparative data on antihypertensive medication classes remain limited. We examined associations between antihypertensive medication class and liver fibrosis and mortality in US adults with MASLD. METHODS: We conducted a prevalent-user analysis using National Health and Nutrition Examination Survey (NHANES) 1999-2018 data linked to mortality through 2019. Antihypertensive exposure was defined at baseline based on self-reported medication use, consistent with a prevalent-user design. Steatosis was defined by the US Fatty Liver Index (US-FLI). Fibrosis was assessed using FIB-4 and APRI within a model-based framework derived from vibration-controlled transient elastography. Analyses comparing antihypertensive classes were restricted to monotherapy users. Logistic regression and Cox models with inverse probability of treatment weighting and survey weights were applied. RESULTS: Among participants with MASLD receiving antihypertensive monotherapy (n = 458; 86 deaths), ACEIs and ARBs were associated with lower all-cause mortality compared with calcium channel blockers (CCBs, reference group; n = 47; 15 deaths) (ACEIs: adjusted hazard ratio [aHR], 0.30; 95% CI, 0.11-0.82; ARBs: 0.25; 95% CI, 0.07-0.94). In cross-sectional analyses, antihypertensive medication use was associated with lower odds of liver fibrosis defined by FIB-4 and APRI within US-FLI-defined populations (MASLD: FIB-4 aOR 0.51 [0.29-0.91]; APRI aOR 0.49 [0.28-0.89]). Findings were broadly consistent across sensitivity analyses, including alternative model specifications and expanded covariate adjustment. CONCLUSIONS: Antihypertensive medication use, particularly ACEIs and ARBs, was associated with lower fibrosis prevalence and all-cause mortality in MASLD. These findings are hypothesis-generating and require confirmation in prospective studies."}