The association between fatty liver disease and blood pressure in a population-based cohort study

Objective: The aim of the present study was to investigate the association of fatty liver disease (FLD) with blood pressure and hypertension in a general population sample with prospective 5-year follow-up examinations. Design and Methods: We used data from the Study of Health in Pomerania (SHIP), conducted in the north-eastern part of Germany. The study population comprised 3191 individuals aged 20–79 years. FLD was defined as the presence of a hyperechogenic pattern of the liver and increased serum alanine transferase (ALT) levels. Results: Multivariable analyses revealed that FLD was associated with increased diastolic blood pressure and hypertension at baseline and with increased systolic blood pressure and hypertension at follow-up. For example, the chance of hypertension at baseline was 2.8-fold (CI=1.3–6.2) and 3.1-fold at follow-up (CI=1.7–5.8) higher in individuals with FLD as defined by liver hyperechogenity and increased ALT levels compared to individuals without FLD. In the subgroup of individuals not receiving antihypertensive medication, FLD was associated with all blood pressure-related variables at baseline and follow-up. Analyses further suggest that these associations were independent of alcohol consumption and other potential confounders. Conclusion: FLD defined by liver hyperechogenity and increased ALT levels is associated with progression of blood pressure over time and incident hypertension. In individuals with FLD, blood pressure should be checked regularly and interventions addressing behavioural risk factors for FLD and hypertension should be initiated if necessary. Ultrasound should be implemented as a method to detect FLD in individuals with increased ALT levels in routine medical care.