Table 1.
NAFLD as an independent factor of arterial hypertension.
| Reference | Study Design | Study Population | NAFLD Diagnosis | Follow-Up | Key Results |
|---|---|---|---|---|---|
| R.L. Vasunta et al., 2012 [30] | Analysis of the dataset from the population-based epidemiological case–control OPERA (The Oulu Project Elucidating Risk of Atherosclerosis) study. Cross-sectional design | 890 hypertensive (n = 433) and normotensive (n = 457) individuals (mean age ± SD 51.0 ± 6.0 years; 49% were males) | Abdominal ultrasound | N/A | After adjusting for BMI, gender and age, individuals with NAFLD had significantly higher ambulatory daytime (p < 0.02) and nighttime (p < 0.05) SBP values, compared with individuals without fatty liver disease |
| J.H. Ryoo et al., 2014 [28] | Prospective cohort study | 22,090 Korean men without AH (mean age ± SD: 42.1 ± 6.8 years). NAFLD was diagnosed in 7561 patients (34.2%) | Abdominal ultrasound, exclusion of liver disease of other etiology | 5 years | The incidence of AH was higher in patients with NAFLD vs. those without it (30.1% vs. 14.4%, p < 0.001). After adjusting for multiple covariates, the OR for developing AH were higher in mild NAFLD patients (1.07; 95% CI 1.00–1.15) and moderate to severe NAFLD patients (1.14; 95% CI 1.00–1.30), compared with the control group (p < 0.001) |
| K.C. Sung et al., 2014 [29] | Retrospective cohort study | 11,448 patients without AH at baseline. Of them, 911 patients developed AH (mean age ± SD: 42.28 ± 6.45 years; 84.4% were males), and 1418 patients developed fatty liver (mean age ± SD: 40.84 ± 5.58 years; 83.9% were males) during follow-up | Abdominal ultrasound, exclusion of liver disease of other etiology | 5 years | The development of fatty liver was associated with the incidence of AH even after adjusting for multiple confounding factors (adjusted OR 1.60; 95% CI 1.30, 1.96; p < 0.001). |
| J.H. Huh et al., 2015 [31] | Prospective cohort study (analysis of the data from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population [KoGES-ARIRANG]) | 1521 adults (31.8% were males) aged 40 to 70 years without AH at baseline | FLI | Mean follow-up period was 2.6 years | During the follow-up period, 153 subjects (10.06%) developed AH. The OR values (95% CI) for developing AH in the 30 ≤ FLI ≤ 59 group and FLI ≥ 60 group were 1.87 (1.2–2.91) and 2.22 (1.16–4.25), respectively, compared with values in the FLI < 30 group, after adjustment for confounding factors (e.g., liver enzyme activity, adiponectin, IR, and etc.) |
| F. Bonnet et al., 2017 [32] |
Analysis of data from two longitudinal studies in subjects without AH:
|
Men and women aged 30–65 years; n = 2565 (D.E.S.I.R. cohort) and n = 321 (RISC cohort). Of them, 1021 subjects (39.8%) from the D.E.S.I.R. cohort (mean age ± SD: 48 ± 9 years; 54% were males) and 63 (19.6%) subjects from the RISC cohort (mean age ± SD: 47.6 ± 7.7 years; 62% were males) developed AH during follow-up | FLI |
|
After adjusting for confounding factors, only GGT was significantly associated with the onset of AH (standardized OR, 1.21; 95% CI, 1.10–1.34; p = 0.0001). FLI as a continuous value or ≥60 at baseline was predictive of the onset incidence of AH in the multivariate model |
| R. Lorbeer et al., 2017 [33] | Cross-sectional data from the MRI subset of the KORA FF4 study |
384 participants (58.1% males) aged 39–73 years | HFF measured in the left and right lobe of the liver using single voxel multi-echo 1H-spectroscopy and at the level of the portal vein using a multi-echo Dixon-sequence (MRI) | N/A | The best prediction of AH among all HFF variables was observed for the left lobe HFF threshold (3.57%; OR = 2.62, p = 0.003). Alcohol consumption appeared to be an effect modifier for the association between HFF and AH (non-drinkers: OR = 3.76, p = 0.025; alcohol consumers: OR = 1.59, p = 0.165). |
| P. Liu et al., 2018 [34] | Analysis of the dataset from the Dongfeng–Tongji cohort study | 6704 eligible hypertension-free subjects and 9328 NAFLD-free subjects at baseline (mean age 59.8 ± 7.6 years; 36.3% were males) | Abdominal ultrasound, exclusion of liver disease of other etiology | N/A | Incidental NAFLD, as well as persistent NAFLD, were significantly associated with an increased OR for incidental AH (OR 1.49, 95% CI 1.26–1.76, p < 0.0001 and OR 1.50, 95% CI 1.27–1.78, p < 0.0001, respectively). At the same time, incidental AH was associated with risk of incidental NAFLD (OR 1.45, 95% CI 1.23–1.71, p < 0.0001). Similar data were obtained for persistent AH (OR 1.61, 95% CI 1.35–1.92, p < 0.0001) |
| J.H. Roh et al., 2020 [35] | Retrospective analysis of the data set from the National Health Insurance Service–National Sample Cohort 2.0 (NHIS-NSC 2.0) | 334,280 healthy Korean people with no known comorbidities aged ≥20 years. Of these, 24,678 subjects (7.4%) developed AH during follow-up (60.6% aged ≥ 50 years, 51.1% men) | FLI The following quartiles of the FLI values were suggested: Q1, 0–4.9; Q2, 5.0–12.5; Q3, 12.6–31.0; Q4, >31.0. |
The median follow-up was 5.2 years (interquartile range: 3.5–6.3) | The highest FLI values were associated with an increased risk of new onset AH (adjusted OR between Q4 and Q1 FLI values 2.330; 95% CI 2.218–2.448; p < 0.001). |
| Y. Higashiura et al., 2021 [36] | Retrospective cohort study | 15,965 subjects (9566 males, mean age ± SD: 45 ± 11 years; 6499 females, mean age ± SD 45 ± 11 years) | FLI | The mean follow-up period was 6.0 years (range: 1–10 years) | Over a 10-year period, 2,304 men (24.3%) and 745 women (11.5%) developed AH. The combination of FLI with traditional risk factors significantly improved the discriminatory power of the AH risk stratification model for both men and women (p < 0.001) |
| S. Ciardullo et al., 2022 [37] | A systematic review and meta-analysis of 11 observational studies | 390,348 middle-aged individuals (52% men) | Abdominal ultrasound in 6 studies (n = 45,924) Computed tomography in 1 study (n = 1051) FLI in 4 studies (n = 343,373) |
Mean follow-up period was 5.7 years (range, 2.6–9 years) | NAFLD was associated with a 1.6-fold increase in the risk of developing AH |
| E. Siafi et al., 2023 [38] | Prospective cohort study | 903 hypertensive patients without a history of cardiovascular disease (mean age ± SD: 52.7 ± 11.4 years; 55% were males) | FLI | Mean follow-up period was 5.2 ± 3.2 years | Patients with FLI < 60 (n = 625) had better BP control vs. their counterparts with FLI ≥ 60 (n = 278) at follow-up (43% vs 33%, p = 0.02). |
AH = arterial hypertension; BMI = body mass index; BP = blood pressure; CI = confidence interval; DBP = diastolic blood pressure; FLI = fatty liver index; HFF = hepatic fat fraction; hsCRP = high-sensitivity C-reactive protein; IR = insulin resistance; MRI = magnetic resonance imagining; N/A = not applicable; NAFLD = non-alcoholic fatty liver disease; OR = odds ratio; SBP = systolic blood pressure; SD = standard deviation.