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Nonalcoholic Fatty Liver Disease and Advanced Fibrosis in US Adults Across Blood Pressure Categories

医学 非酒精性脂肪肝 内科学 糖尿病 血压 代谢综合征 脂肪肝 胃肠病学 纤维化 肥胖 疾病 内分泌学
作者
Stefano Ciardullo,Tommaso Monti,Isabella Sala,Guıdo Grassı,Giuseppe Mancia,Gianluca Perseghin
出处
期刊:Hypertension [Lippincott Williams & Wilkins]
卷期号:76 (2): 562-568 被引量:49
标识
DOI:10.1161/hypertensionaha.120.15220
摘要

Nonalcoholic fatty liver disease (NAFLD) is common in patients with hypertension but controversy exists as to whether screening for this condition should be performed. Here, we evaluate the prevalence of NAFLD and advanced fibrosis in US adults across blood pressure categories and estimate the number of patients who require referral to hepatologists. In this cross-sectional analysis of 11 489 adults from the 2005 to 2016 National Health and Nutrition Examination Survey, participants were segregated as having optimal, normal, high normal, and elevated blood pressure according to the 2018 European Society of Cardiology/Hypertension guidelines. NAFLD was defined using the US fatty liver index, whereas fibrosis was assessed using the NAFLD fibrosis score, fibrosis-4, and Hepamet Fibrosis Score. NAFLD prevalence increased progressively from optimal (16.5%) to normal (34.5%), high normal (39.9%), and elevated blood pressure (50.2%, P <0.001). Patients with hypertension also showed a higher prevalence of advanced fibrosis (3%–9%, based on the specific biomarker used). When the screening flowchart from the European Association for the Study of the Liver, Diabetes, and Obesity guidelines was applied to patients with hypertension, 26.7% needed referral to hepatologists. Risk of referral was higher in Hispanic patients and those with diabetes mellitus, heart failure, and an altered urinary albumin excretion. NAFLD is highly prevalent in US adults with hypertension and a quarter of them would need to be referred to hepatologists because of a high risk of advanced fibrosis. While future studies on cost-effectiveness are needed, screening for NAFLD in these patients could be beneficial.
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