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Nocturnal hypertension represents an uncontrolled burden in patients with metabolic dysfunction-associated steatotic
Anna Martin1, Sonja Lang1, Felix Schifferdecker1
1University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gastroenterology and Hepatology.
Insights
Nocturnal hypertension (NH) affects over half of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Key risk factors include type 2 diabetes, dyslipidemia, and increased liver stiffness, necessitating 24-h ambulatory blood pressure monitoring for cardiovascular risk assessment.
Area of Science:
- Cardiology
- Hepatology
- Metabolic Diseases
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant risk factor for cardiovascular morbidity and mortality.
- Arterial hypertension (AH) is also a critical risk factor in MASLD patients, with an estimated 50% prevalence.
- 24-h ambulatory blood pressure monitoring (24-h-ABPM) is crucial for diagnosing hypertension and its subtypes, like nocturnal hypertension (NH), a potent cardiovascular risk predictor.
Purpose of the Study:
- To determine the prevalence of nocturnal hypertension (NH) in patients with MASLD.
- To identify associated risk factors for NH in this patient population.
Main Methods:
- Prospective recruitment of 226 MASLD patients with or without known AH.
- Performance of 24-h-ABPM and repeated office blood pressure measurements.
- Inclusion of 218 patients' 24-h-ABPM data in the final analysis.
Main Results:
- Nocturnal hypertension (NH) was detected in 51.3% of the analyzed MASLD patients.
- Of those with NH, 48.2% had uncontrolled hypertension despite antihypertensive treatment.
- Independent risk factors for NH included type 2 diabetes mellitus (T2DM), dyslipidemia, and increased liver stiffness.
Conclusions:
- MASLD patients with co-existing T2DM, dyslipidemia, and elevated liver stiffness exhibit a high prevalence of NH.
- These patients are at increased risk for adverse cardiovascular events.
- Routine 24-h-ABPM is recommended for early detection and management of NH in at-risk MASLD patients.
Backgroundaims:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is an independent risk factor for cardiovascular morbidity and mortality. Another critical risk factor in these patients is arterial hypertension (AH). Although it is estimated that 50% of MASLD patients are suffering from AH, 24-h ambulatory blood pressure monitoring (24-h-ABPM), the gold standard for diagnosing hypertension, is often neglected. However, only 24-h-ABPM can identify hypertension subtypes, particularly nocturnal hypertension (NH), which is a stronger predictor of cardiovascular mortality than daytime or 24-h blood pressure. The aim of this study was to investigate the prevalence of NH in MASLD patients and to identify associated risk factors.
Methods:
To this end, 226 MASLD patients with or without known AH were prospectively recruited in an outpatient liver department and underwent 24-h-ABPM together with repeated office-blood-pressure measurements.
Results:
24-h-ABPM datasets from 218 patients were included in the final analysis. NH was observed in 112 patients (51.3%), of whom 54 (48.2%) were receiving antihypertensive treatment (uncontrolled hypertension). Univariable regression analysis showed that age, increased waist-to-hip ratio, a waist-to-height ratio ≥0.5, type 2 diabetes mellitus (T2DM), dyslipidemia, a lower estimated glomerular filtration rate and increased liver stiffness were significantly associated with a higher risk of NH. In multivariable regression analysis, T2DM [odds ratio (OR) 2.56; 95% confidence interval (CI) 1.09-6.23; P = 0.033], dyslipidemia (OR 3.30; 95% CI, 1.67-6.73; P = 0.001) and liver stiffness (OR 1.09; 95% CI, 1.02-1.18; P = 0.021) were identified as independent risk factors.
Conclusions:
In conclusion, particularly MASLD patients with accompanying T2DM, dyslipidemia, and increased liver stiffness should undergo 24-h-ABPM to detect and treat NH, as they are at the highest risk of adverse cardiovascular events.
Clinical Trial:
NCT-04543721.
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