Oikonomou Dimitrios, Georgiopoulos Georgios, Katsi Vassiliki, Kourek Chris, Tsioufis Constantinos, Alexopoulou Alexendra, Koutli Evaggelia, Tousoulis Dimitrios
Department of Cardiology, 'Evaggelismos' General Hospital of Athens.
First Department of Cardiology.
Eur J Gastroenterol Hepatol. 2018 Sep;30(9):979-985. doi: 10.1097/MEG.0000000000001191.
To provide a comprehensive review summarizing the existing evidence on the association between nonalcoholic fatty liver disease (NAFLD) and hypertension (HT) independent of other components of metabolic syndrome.
We searched the literature through Medline and the Cochrane Library for studies evaluating the relationship between hypertension and fatty liver disease.
Studies testing this association are limited, but agree that HT and fatty liver disease are inter-related independent of other components of the metabolic syndrome such as obesity and diabetes mellitus. Clinical evidence shows that NAFLD is associated with new-onset HT, whereas increased blood pressure is related to the development of fatty liver disease and the possible subsequent progression to liver fibrosis. Insulin resistance and activation of the renin-angiotensin-aldosterone system (RAAS) might provide potential pathophysiologic links between these clinical entities. Until further evidence is available, patients with HT should be meticulously evaluated and treated for fatty liver disease and vice versa. RAAS inhibitors have been tested in NAFLD, presenting a favorable profile by decreasing insulin resistance and fibrosis progression.
NAFLD and HT are associated independent of traditional cardiovascular risk factors. Insulin resistance appears to be the main linking mechanism. Although RAAS inhibitors are the most beneficial treatment option for HT in patients with NAFLD, randomized studies on the administration of these agents in HT patients with NAFDL are warranted to provide optimal treatment options in these high cardiovascular risk individuals.
提供一篇全面综述，总结关于非酒精性脂肪性肝病（NAFLD）与高血压（HT）之间关联的现有证据，且独立于代谢综合征的其他组分。
我们通过医学文献数据库（Medline）和考克兰图书馆检索文献，以查找评估高血压与脂肪性肝病之间关系的研究。
检验这种关联的研究有限，但一致认为高血压与脂肪性肝病相互关联，独立于代谢综合征的其他组分，如肥胖和糖尿病。临床证据表明，NAFLD与新发高血压相关，而血压升高与脂肪性肝病的发生以及随后可能进展为肝纤维化有关。胰岛素抵抗和肾素 - 血管紧张素 - 醛固酮系统（RAAS）的激活可能为这些临床实体之间提供潜在的病理生理联系。在有更多证据之前，高血压患者应仔细评估并治疗脂肪性肝病，反之亦然。RAAS抑制剂已在NAFLD中进行测试，通过降低胰岛素抵抗和纤维化进展显示出良好的效果。
NAFLD与HT相关，独立于传统心血管危险因素。胰岛素抵抗似乎是主要的联系机制。尽管RAAS抑制剂是NAFLD患者高血压最有益的治疗选择，但有必要对这些药物在NAFLD高血压患者中的应用进行随机研究，以便为这些心血管高风险个体提供最佳治疗方案。
