Effect of hypertension on long-term adverse clinical outcomes and liver fibrosis progression in MASLD.
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Zhou Xiao-Dong, Lian Li-You, Chen Qin-Fen, Kim Seung Up, Cheuk-Fung Yip Terry, Petta Salvatore, Nakajima Atsushi, Tsochatzis Emmanuel, Shi Junping, Chan Wah-Kheong, Boursier Jérôme, Bugianesi Elisabetta, Yilmaz Yusuf, Hagström Hannes, Romero-Gomez Manuel, Alswat Khalid, Calleja José Luis, Takahashi Hirokazu, de Lédinghen Victor, Shalimar, Castéra Laurent, Sanyal Arun J, Goh George Boon-Bee, Newsome Philip N, Fan Jian-Gao, Lai Michelle, Aggarwal Sandeep, Kechagias Stergios, Hiasa Yoichi, Dayal Bheesham, Zhang Zhongtao, George Jacob, El-Kassas Mohamed, Chen Jinjun, You Hong, Abu Dayyeh Barham K, Sheng Huiping, Adams Leon A, Wang Jing, He Fangping, Liang Huiqing, Yang Yong-Feng, Chi Xiaoling, Zhong Bihui, Bi Yan, Mi Yuqiang, Zhu Yongfen, Bai Rixing, Zhang Jing, Wang Bingyuan, Song Jinghai, Deng Hong, Xie Qing, Bai Lang, Xin Yongning, Xie Wen, Li Jie, Fournier-Poizat Céline, Zoncapè Mirko, Xia Tianyi, Ju Shenghong, Wu Chutian, Lee Hye Won, Wong Grace Lai-Hung, Armandi Angelo, Shang Ying, Pennisi Grazia, Llop Elba, Yoneda Masato, de Saint-Loup Marc, Canivet Clemence M, Lara-Romero Carmen, Gallego-Durán Rocio, Carrillo-Fernández Paloma, Asgharpour Amon, Teh Kevin Kim-Jun, Mahgoub Sara, Chan Mandy Sau-Wai, Lin Huapeng, Liu Wen-Yue, Song Sherlot Juan, Al-Hamoudi Waleed K, Isoda Hiroshi, Miyake Teruki, Satapathy Sanjaya K, Li Mengyi, Sharma Keshni, Emadeldeen Mohammed, Zhou Ling, Tong Xiaofei, Bazerbachi Fateh, Fan Xiaotang, Xiao Huanming, Ye Junzhao, Xu Liang, Wang Xiaolin, Targher Giovanni, Byrne Christopher D, Shapiro Michael D, Tacke Frank, Wai-Sun Wong Vincent, Zheng Ming-Hua, VCTE-Prognosis Study Group, Paired Liver Biopsy Group
Аннотация
METHODS: Three multicenter large cohorts were analyzed: the UK Biobank (UKBB) cohort to assess the risk of adverse clinical outcomes, the VCTE-Prognosis cohort to assess liver stiffness/fibrosis progression, and the Paired Liver Biopsy cohort to assess histologic liver fibrosis progression. Adverse clinical outcomes were defined as all-cause mortality, cardiovascular events, and/or liver-related events. Liver stiffness progression was defined as an increase in liver stiffness measurement from <10 kPa to ≥10 kPa or an increase of ≥20% for baseline liver stiffness measurement ≥10 kPa. Liver fibrosis progression was defined as a 1-stage fibrosis stage increase. Cox regression and Kaplan-Meier analyses were used to evaluate the impact of baseline hypertension on outcomes.
RESULTS: A total of 107,316 adults from the UKBB cohort, 8,169 from the VCTE-Prognosis cohort, and 1,670 from the Paired Liver Biopsy cohort were included. The prevalence of hypertension was 37.1%, 33.4%, and 48.9%, respectively. In the UKBB cohort, hypertension was associated with long-term adverse clinical outcomes (adjusted hazard ratio [HR] 1.30, 95% CI 1.26-1.33, p <0.001). In the VCTE-Prognosis cohort, hypertension was associated with a higher risk of liver stiffness progression (adjusted HR 1.57, 95% CI 1.30-1.90, p <0.001), while in the Paired Liver Biopsy cohort, hypertension was associated with a greater risk of histologic liver fibrosis progression (adjusted HR 1.41, 95% CI 1.12-1.78, p = 0.004). Subgroup and sensitivity analyses supported these findings.
CONCLUSIONS: Hypertension is a modifiable risk factor that increases the risk of adverse clinical outcomes and progression of liver stiffness and fibrosis in MASLD.
IMPACT AND IMPLICATIONS: This study provides robust evidence from three large multicenter cohorts demonstrating that hypertension is independently associated with increased risks of adverse clinical outcomes and liver fibrosis progression in individuals with MASLD. These findings reveal that hypertension, traditionally managed from a cardiovascular perspective, also plays a critical and underrecognized role in liver disease progression, making them highly relevant for hepatologists, cardiologists, and primary care providers. Incorporating non-invasive fibrosis assessments into routine care for patients with MASLD and hypertension may facilitate early risk stratification and support targeted interventions to reduce both hepatic and cardiovascular complications.