MASKED HYPERTENSION IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE – AN UNDERESTIMATED RISK?

Abstract

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension are major cardiovascular risk factors sharing a bi-directional relationship. Although nearly half of MASLD patients are suffering from arterial hypertension, data on the prevalence of different hypertension phenotypes (e.g. masked hypertension) in this patient population are scarce. Masked hypertension, which is defined by normal office blood pressure but elevated blood pressure in the ambulatory 24-hour blood pressure measurement (24-h-ABPM), often remains undetected, although it has a comparable risk for adverse cardiovascular events as sustained hypertension. Therefore, the identification of this hypertension phenotype in MASLD patients seems highly relevant. Design and method: To analyze the prevalence of masked hypertension and to improve hypertension management in MASLD patients we integrated a 24-h-ABPM-based hypertension screening and control program among MASLD patients in our outpatient liver department. A total of 226 MASLD patients were recruited during regular follow-up visits and recording of office blood pressure and 24-h-ABPM measurements were performed according to a standardized protocol. Results: For the final analysis, 218 data sets were evaluated. The median age of the included 218 patients was 51 years, 48.2% were female. 101 (46.3%) MASLD patients had prior history of hypertension. At the time of ABPM 93 (92.1%) of these patients received antihypertensive treatment. Masked hypertension was identified in 46 (21.1%) MASLD patients, 20 (43.5%) of whom were receiving antihypertensive treatment (masked uncontrolled hypertension). Interestingly, 14 (30.4%) MASLD patients with masked hypertension had isolated nocturnal masked hypertension. Furthermore, a non-dipping blood pressure pattern was recognized in 28 (60.9%) MASLD patients with masked hypertension. Conclusions: Due to the high rates of masked hypertension and abnormal nocturnal blood pressure dipping, which both represent important risk factors for adverse cardiovascular events, the establishment of hypertension screening and management programs in this high-risk population seems urgently needed. Controlled hypertension reduces the risk of cardiovascular events in this vulnerable population and, due to the strong link between MASLD and hypertension, possibly also slow the progression of MASLD to advanced liver fibrosis or cirrhosis.