Angiotensin type II receptor blockers (ARBs) are the most widely used anti-hypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort.Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,406), valsartan (n = 6,040), and losartan (n = 9,126) were retrieved from the clinical data warehouse of two tertiary hospitals. Patients with alanine aminotransferase (ALT) levels5 times the upper normal limit were assessed according to the Roussel Uclaf Causality Assessment Method (RUCAM).A total of 27,115 patients were enrolled, including 14,630 (54.0%) men, with a mean age of 64.6 years (standard deviation, 13.6). During 31,717 person-years of ARB therapy, serum ALT levels120 IU/L were found in 558 (2.1%) person-years, and levels200 IU/L were found in 155 (0.6%) person-years. The incidence of ALT elevation120 IU/L per 10Approximately 2% of patients receiving ARB therapy had significant ALT elevation (4.24/10
