Nonalcoholic fatty liver disease is associated with blood pressure in hypertensive and nonhypertensive individuals from the general population with normal levels of alanine aminotransferase

Abstract

Nonalcoholic fatty liver disease (NAFLD) has been associated with hypertension in specific population groups and in cases with elevated levels of alanine aminotransferase (ALT). This study aimed to determine the strength of the association between NAFLD with prevalent hypertension and with high-normal blood pressure (BP) in nonhypertensive individuals from the general population regardless of ALT levels. The observational study included 454 participants selected randomly from the general population aged 50-75 years old. Adjusted odds ratios and 95% confidence intervals (CIs) of NAFLD with hypertension were calculated by binary multivariate regression analysis controlling for traditional risk factors and ALT levels. Similar calculations were performed to assess the independent association of NAFLD with high-normal systolic (130-139 mmHg) and diastolic (85-89 mmHg) BP in the subgroup of nonhypertensive participants. The prevalence of NAFLD was 38.5% (95% CI, 34.0-43.0) in the entire sample and 49.5% (95% CI, 44.9-54.1) in hypertensive participants. The percentage of cases with hypertension was 21.2% greater in individuals with NAFLD than those without NAFLD (95% CI, 11.8-30.6, P<0.0005). NAFLD was independently associated with prevalent hypertension with an adjusted odds ratio of 1.71 (95% CI, 1.10-2.65, P=0.017). Among nonhypertensive participants, NAFLD was also independently associated with high-normal systolic BP (adjusted odds ratio 2.13, 95% CI, 1.08-4.20, P=0.029) but not with high-normal diastolic BP. In middle-aged and old adults from the general population, NAFLD is associated with an independent risk of identifying hypertension and high-normal systolic BP. Detection of NAFLD, even with normal ALT levels, should serve as an opportunity to identify metabolic and BP abnormalities and intensify lifestyle modification.