title: Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk.
abstract: OBJECTIVE
  To determine the relationship between clinically relevant blood pressure (BP) groups and nonalcoholic fatty liver disease (NAFLD) presence and severity especially in the milieu of other metabolic risk factors.
  
  
  METHODS
  From a Brazilian cohort of 5362 healthy middle-aged men and women who presented for yearly physical examination and testing, the cross-sectional relationship between BP categories and NAFLD was assessed. BP groups were categorized as normal, prehypertension (PHT), and hypertension (HTN) according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classification. NAFLD was ultrasound diagnosed, excluding persons with alcohol consumption more than 20 g/day. NAFLD severity was estimated using the Fibrosis-4 (FIB-4) risk score.
  
  
  RESULTS
  The prevalence of NAFLD was 36.2%. Participants with NAFLD were older (mean 46 vs. 42 years, P < 0.001) and had elevated BMI (mean 29.0 vs. 24.7 kg/m, P < 0.001). The prevalence of NAFLD among persons with normal BP, PHT, and HTN was 16.5, 37.5, and 59.3%, respectively. In multivariate analyses, PHT and HTN were associated with elevated odds of NAFLD (PHT-adjusted odds ratio 1.3, 95% confidence interval 1.1, 1.6; HTN-adjusted odds ratio 1.8, 95% confidence interval 1.4-2.3) compared with normal BP. Among nonobese hypertensive patients, BP control (BP < 140/90 mmHg) was independently associated with 40% lower odds of prevalent NAFLD. Compared with hypertensive patients, both normotensive individuals and prehypertensive patients were more likely to have a low fibrosis risk (FIB-4 ≥ 1.3).
  
  
  CONCLUSIONS
  Prevalent NAFLD may be seen early in the development of hypertension, even in the absence of other metabolic risk factors. Controlling BP among nonobese hypertensive patients may be beneficial in preventing or limiting NAFLD.
authors.affiliation: aCenter for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida bJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland cRobert Stempel College of Public Health, Florida International University, Miami, Florida dSchool of Medicine, Department of Medicine, Emory University, Atlanta, Georgia, USA eHospital Israelita Albert Einstein fHeart Institute (InCor), University of Sao Paolo Medical School Hospital, Sao Paolo, Brazil gHerbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Ehimen C
authors.initials: EC
authors.lastname: Aneni
authors.forename: Ebenezer T
authors.initials: ET
authors.lastname: Oni
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Agatston
authors.forename: Theodore
authors.initials: T
authors.lastname: Feldman
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Raquel D
authors.initials: RD
authors.lastname: Conçeicao
authors.forename: Jose A M
authors.initials: JA
authors.lastname: Carvalho
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D016017:Odds Ratio; D058246:Prehypertension / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index