Uncontrolled hypertension: a neglected risk in patients with NAFLD

Background Growing evidence indicates a bi-directional relationship between non-alcoholic fatty liver disease (NAFLD) and hypertension. Although hypertension affects up to 50% of all NAFLD patients and is a major risk factor for adverse cardiovascular events, integrative management programs as well as valid information on hypertension control among NAFLD patients are lacking. Thus, we integrated a 24-h-ambulatory-blood-pressure monitoring (24-h-ABPM) based hypertension screening and control program into NAFLD outpatient-care.

Methods 226 NAFLD patients were recruited during regular follow-up visits and underwent office-blood-pressure (OBP) measurements as well as 24-h-ABPM following a standardized protocol. Uncontrolled hypertension status was defined as elevated out-of-office BP in treated or untreated individuals.

Results 218 data sets were eligible for final analysis. At the time of ABPM, 101 NAFLD patients had a medical history of hypertension, of whom 93 (92.1%) were treated. Controlled hypertension (OBP and ABPM normotension) was confirmed in only 23 of 93 (24.7%) NAFLD patients with known and treated hypertension, while 44 (47.3%) participants on antihypertensive treatment revealed sustained uncontrolled hypertension (OBP and ABPM hypertension). Masked hypertension (normal OBP with elevated out-of-office BP) was identified in 42 (19.3%) NAFLD patients. A new diagnosis of sustained hypertension was established in 33 NAFLD patients. Overall, 127 of 218 (58.3%) NAFLD patients showed an uncontrolled hypertension status.

Conclusions Given the high rate of uncontrolled hypertension among NAFLD patients, the implementation of hypertension management programs including 24-h-ABPM into patient-centered care is urgently needed. Improving hypertension control could help to reduce the risk of cardiovascular events in patients with NAFLD.

Publikationsverlauf

Artikel online veröffentlicht:
26. Januar 2022