Introduction:
Hypertension is the most common causal risk factor for coronary artery disease. The increased prevalence of hypertension in those with nonalcoholic fatty liver disease (NAFLD) is well studied. Less well studied is the prevalence of hypertension in lean (BMI<25) individuals with NAFLD. This warrants attention since the burden of cardiovascular disease is increasingly shifting to the lean.
Methods:
The data for this study was obtained from a cohort of 6464 Brazilians (41.4+/-9 Y, 62% M) free of diabetes mellitus or cardiovascular disease. Of these, 39% (n=2508) were lean (BMI<25). Hypertension was defined as systolic BP (SBP) ≥ 140 mmHg or DBP ≥90 mmHg, self-identification as hypertensive or being on medication for hypertension. NAFLD was diagnosed using ultrasound in those with <20g/d alcohol intake.
Results:
The prevalence of hypertension in the lean population was nine percent. NAFLD was significantly associated with the presence of hypertension. The prevalence of hypertension was 16% and 8% in those with and without NAFLD respectively (p<0.001). In a multivariate analysis controlling for age, gender, triglyceride and high density lipoprotein cholesterol, the risk of hypertension in those with NAFLD was 1.54 times those without NAFLD(p<0.001).
Conclusion:
There is significantly increased prevalence of hypertension in lean, healthy individuals with NAFLD. This association is present even after adjusting for age, gender and metabolic risk factors. This relationship needs to be explored further since an increasing number of lean individuals have NAFLD on examination (Younossi et al., 2012).
Effect of Nonalcoholic Fatty Liver Disease and Metabolic Risk Factors on Waitlist Outcomes in Patients With Hepatocellular Carcinoma