AUTHOR=Ng Cheng Han , Wong Zhen Yu , Chew Nicholas W. S. , Chan Kai En , Xiao Jieling , Sayed Nilofer , Lim Wen Hui , Tan Darren Jun Hao , Loke Ryan Wai Keong , Tay Phoebe Wen Lin , Yong Jie Ning , Kong Gywneth , Huang Daniel Q. , Wang Jiong-Wei , Chan Mark , Dalakoti Mayank , Tamaki Nobuharu , Noureddin Mazen , Siddiqui Mohammad Shadab , Sanyal Arun J. , Muthiah Mark 

TITLE=Hypertension is prevalent in non-alcoholic fatty liver disease and increases all-cause and cardiovascular mortality

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.942753

DOI=10.3389/fcvm.2022.942753

ISSN=2297-055X

ABSTRACT=Background & Aims: 
Hypertension (HTN) is a common comorbidity in non-alcoholic fatty liver disease (NAFLD) affecting up to 40% of individuals. Yet, the impact of HTN and its control, on outcomes in NAFLD remains unclear. Therefore, we aimed to examine the impact of HTN on survival outcomes in a longitudinal cohort of NAFLD patients. 

Methods: 
The analysis consisted of adults in the National Health and Nutrition Examination Survey (NHANES) from 1999-2018 with data on socio-demographic characteristics and comorbidities. NAFLD was diagnosed with fatty liver index (FLI) and United States-FLI at a cut-off of 60 and 30 respectively in the substantial absence of alcohol use. Multivariate regression analysis was conducted to adjust for confounders.

Results: 
45,302 adults were included and 27.83% were identified to have NAFLD. Overall, 45.65% and 35.12% of NAFLD patients had HTN and uncontrolled HTN respectively. Hypertensive NAFLD had an increased risk of all-cause mortality (HR: 1.25, CI: 1.16 to 1.32, p<0.01) and cardiovascular disease (CVD) mortality (SHR: 1.58, CI: 1.17 to 2.11, p<0.01). Well controlled HTN had no significant increased risk of all-cause mortality (HR: 1.20, CI: 0.97 to 1.47, p=0.09) and CVD mortality (SHR: 1.38, CI: 0.86 to 2.20, p=0.19). 

Conclusion: 
Despite the significant burden of HTN in NAFLD, up to a fifth of patients have adequate control and the lack thereof significantly increases the mortality risk. With the significant association of HTN in NAFLD, NAFLD patients should be managed with a multidisciplinary team to improve longitudinal outcomes.