From the Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy (S.C., G.M., G.P.).
School of Medicine and Surgery (S.C., G.M., G.P.), University of Milano Bicocca, Milan, Italy.
Hypertension. 2020 Aug;76(2):562-568. doi: 10.1161/HYPERTENSIONAHA.120.15220. Epub 2020 Jun 29.
Nonalcoholic fatty liver disease (NAFLD) is common in patients with hypertension but controversy exists as to whether screening for this condition should be performed. Here, we evaluate the prevalence of NAFLD and advanced fibrosis in US adults across blood pressure categories and estimate the number of patients who require referral to hepatologists. In this cross-sectional analysis of 11 489 adults from the 2005 to 2016 National Health and Nutrition Examination Survey, participants were segregated as having optimal, normal, high normal, and elevated blood pressure according to the 2018 European Society of Cardiology/Hypertension guidelines. NAFLD was defined using the US fatty liver index, whereas fibrosis was assessed using the NAFLD fibrosis score, fibrosis-4, and Hepamet Fibrosis Score. NAFLD prevalence increased progressively from optimal (16.5%) to normal (34.5%), high normal (39.9%), and elevated blood pressure (50.2%, <0.001). Patients with hypertension also showed a higher prevalence of advanced fibrosis (3%-9%, based on the specific biomarker used). When the screening flowchart from the European Association for the Study of the Liver, Diabetes, and Obesity guidelines was applied to patients with hypertension, 26.7% needed referral to hepatologists. Risk of referral was higher in Hispanic patients and those with diabetes mellitus, heart failure, and an altered urinary albumin excretion. NAFLD is highly prevalent in US adults with hypertension and a quarter of them would need to be referred to hepatologists because of a high risk of advanced fibrosis. While future studies on cost-effectiveness are needed, screening for NAFLD in these patients could be beneficial.
非酒精性脂肪性肝病（NAFLD）在高血压患者中很常见，但对于是否应该对此类疾病进行筛查仍存在争议。在这里，我们评估了美国成年人在不同血压类别中 NAFLD 和晚期纤维化的患病率，并估计了需要转介给肝病专家的患者数量。在对 2005 年至 2016 年全国健康和营养检查调查中的 11489 名成年人进行的这项横断面分析中，根据 2018 年欧洲心脏病学会/高血压指南，参与者根据最佳、正常、高正常和升高的血压分为四组。使用美国脂肪肝指数定义 NAFLD，使用 NAFLD 纤维化评分、纤维化-4 和 Hepamet 纤维化评分评估纤维化。NAFLD 的患病率从最佳（16.5%）逐渐增加到正常（34.5%）、高正常（39.9%）和升高的血压（50.2%，<0.001）。高血压患者也显示出更高的晚期纤维化患病率（基于特定生物标志物，为 3%-9%）。当应用欧洲肝病研究协会、糖尿病和肥胖症指南的筛查流程图时，26.7%的高血压患者需要转介给肝病专家。西班牙裔患者和患有糖尿病、心力衰竭和尿白蛋白排泄改变的患者的转介风险更高。美国高血压成年人中 NAFLD 的患病率很高，其中四分之一的人由于晚期纤维化的高风险需要转介给肝病专家。虽然需要进行未来关于成本效益的研究，但对这些患者进行 NAFLD 筛查可能是有益的。
