Development of new fatty liver, or resolution of existing fatty liver, over five years of follow-up, and risk of incident hypertension.
OBJECTIVE
Approximately 50% of hypertensive patients have non-alcoholic fatty liver disease (NAFLD), but whether change in fatty liver status over time modifies risk of developing hypertension is uncertain. Our aim was to determine whether a change in fatty liver status (either development of new fatty liver, or resolution of existing fatty liver) over five years modified risk of incident hypertension at five year follow-up.


METHODS
11,448 patients without hypertension were examined at baseline and at five year follow-up, using a retrospective cohort study design. Fatty liver status (absent or present) was assessed at baseline and follow-up using standard ultrasound criteria. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for incident hypertension at follow-up were estimated controlling for potential confounders, compared to the reference group (patients who did not have fatty liver at either baseline or follow-up).


RESULTS
911 patients developed incident hypertension. Incident fatty liver developed during follow-up in 1418 patients and fatty liver at baseline resolved during follow-up in 684 patients. Developing incident fatty liver was associated with incident hypertension, even after adjustment for multiple confounders (aOR=1.60 (95% CI 1.30, 1.96; p<0.001). Further adjustment for change in body mass index between baseline and follow-up only slightly attenuated this association (aOR=1.36 (95% CI 1.10, 1.67; p=0.004). With resolution of fatty liver at follow-up, risk of incident hypertension was not different from the reference group (aOR=1.21 (95% CI 0.90, 1.63; p=0.21).


CONCLUSIONS
Development of incident fatty liver is associated with increased risk of hypertension.
Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: kcmd.sung@samsung.com.
Ki-Chul
KC
Sung
Centre for Population Health Sciences, Lothian Place University of Edinburgh, UK.
Sarah H
SH
Wild
Endocrinology and Metabolism Unit, IDS Building, Southampton General Hospital, University of Southampton, MP 887, Southampton, UK. Electronic address: c.d.byrne@soton.ac.uk.
Christopher D
CD
Byrne
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
Hypertension; Insulin resistance; Metabolic syndrome; Non-alcoholic fatty liver disease; Obesity; Type 2 diabetes