Hypertension and NAFLD risk: Insights from the NHANES 2017–2018 and Mendelian randomization analyses

Abstract

Background: Hypertension and non-alcoholic fatty liver disease (NAFLD) share several pathophysiologic risk factors, and the exact relationship between the two remains unclear. Our study aims to provide evidence concerning the relationship between hypertension and NAFLD by analyzing data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 and Mendelian randomization (MR) analyses. Methods: Weighted multivariable-adjusted logistic regression was applied to assess the relationship between hypertension and NAFLD risk by using data from the NHANES 2017–2018. Subsequently, a two-sample MR study was performed using the genome-wide association study (GWAS) summary statistics to identify the causal association between hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and NAFLD. The primary inverse variance weighted (IVW) and other supplementary MR approaches were conducted to verify the causal association between hypertension and NAFLD. Sensitivity analyses were adopted to confirm the robustness of the results. Results: A total of 3144 participants were enrolled for our observational study in NHANES. Weighted multivariable-adjusted logistic regression analysis suggested that hypertension was positively related to NAFLD risk odds ratio (OR) = 1.677; (95% confidence interval [CI], 1.159–2.423). SBP ≥130 mmHg and DBP ≥80 mmHg were also significantly positively correlated with NAFLD. Moreover, hypertension was independently connected with liver steatosis (β = 7.836 [95% CI, 2.334–13.338]). The results of MR analysis also supported a causal association between hypertension (OR = 7.203 [95% CI, 2.297–22.587]) and NAFLD. Similar results were observed for the causal exploration between SBP (OR = 1.024 [95% CI, 1.003–1.046]), DBP (OR = 1.047 [95% CI, 1.005–1.090]), and NAFLD. The sensitive analysis further confirmed the robustness and reliability of these findings (all P >0.05). Conclusion: Hypertension was associated with an increased risk of NAFLD.

Evaluating the relative importance of different blood pressure indices in screening for NAFLD: a survey report based on a health examination population

“…The association between blood pressure indices and NAFLD has been reported in many studies, with published evidence generally supporting a positive correlation between SBP, DBP, PP, MAP, and NAFLD ( 14 – 16 , 31 – 34 ). However, it's noteworthy that most of these studies focused on evaluating the association of individual blood pressure indices with NAFLD and rarely assessed the impact of different indices on NAFLD risk simultaneously.…”

“…Reports on blood pressure indices in identifying NAFLD are currently quite limited. Most published studies have primarily focused on revealing the association between blood pressure indices and NAFLD ( 14 – 16 , 31 – 34 ), affirming the importance of blood pressure indices in NAFLD risk assessment, even at normal blood pressure levels. After establishing this association, further evaluating the value of blood pressure indices in identifying NAFLD is worth researching and emphasizing.…”

“…Hypertension, with a global prevalence of 31.1% ( 10 ), is a key modifiable risk factor in NAFLD's development and progression ( 11 , 12 ). Recent meta-analyses have shown that the presence of hypertension significantly increased the risk of NAFLD events by 47% ( 13 ), and the latest evidence from Mendelian randomization analysis based on Genome-Wide Association Studies further indicated a causal relationship between hypertension and commonly measured blood pressure parameters SBP, DBP, and NAFLD ( 14 ). Additionally, recent observational studies have confirmed that other blood pressure indices, such as PP and MAP, were also positively correlated with NAFLD, where elevated PP and MAP increased the risk of NAFLD ( 15 , 16 ).…”

Association between hypertension and pressure ulcer: A systematic review and meta‐analysis

“…Hypertension is known to be related not only to cardiovascular events such as coronary heart disease, arrhythmia and heart failure but also to a positive association with Alzheimer's disease, 2 and a direct relationship with cancer incidence and mortality 3 . Recent studies showed that hypertension is associated with non‐alcoholic fatty liver and imbalances of intestinal flora 4,5 . However, it remains unclear whether hypertension causes any other diseases.…”

“… 3 Recent studies showed that hypertension is associated with non‐alcoholic fatty liver and imbalances of intestinal flora. 4 , 5 However, it remains unclear whether hypertension causes any other diseases.…”