Liver function tests in patients with hypertension in primary care: a prospective cohort study

Area of Science:

• Clinical Medicine
• Diagnostic Accuracy
• Primary Care Research

Background:

• Liver function tests (LFTs) are commonly used in UK primary care for monitoring hypertension patients.
• Evidence regarding the outcome benefits of LFTs in this population is limited.

Purpose of the Study:

• To assess the diagnostic accuracy of LFTs for liver disease in hypertensive patients.
• To evaluate the downstream healthcare utilization following LFTs in this cohort.

Main Methods:

• A prospective study utilized data from the Clinical Practice Research Datalink (CPRD).
• 30,000 hypertensive patients with LFTs in 2015 were randomly selected.
• Diagnostic accuracy metrics were calculated against a liver disease reference standard; downstream consultations, referrals, and blood tests within six months were recorded.

Main Results:

• The 1-year incidence of liver disease was 0.5%.
• LFT panels demonstrated modest sensitivity (61.3%) and specificity (73.8%).
• Individual LFT analytes had low positive predictive values (PPVs) from 0.2% to 8.9%. False-positive LFTs led to higher rates of consultations, referrals, and blood tests compared to true negatives.

Conclusions:

• LFTs in primary care for hypertension monitoring exhibit low PPVs and high false-positive rates.
• This leads to increased downstream healthcare utilization, including consultations and further testing.
• Discontinuing routine LFTs may alleviate patient anxiety, reduce GP workload, and lower healthcare expenditures.