夜间高血压是代谢功能障碍相关脂肪性肝病患者中未得到控制的负担。

Nocturnal hypertension represents an uncontrolled burden in patients with metabolic dysfunction-associated steatotic liver disease.

作者信息

Martin Anna, Lang Sonja, Schifferdecker Felix, Allo Gabriel, Chon Seung-Hun, Neumann-Haefelin Christoph, Demir Münevver, Steffen Hans-Michael, Kasper Philipp

机构信息

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Gastroenterology and Hepatology.

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Cologne, Germany.

出版信息

J Hypertens. 2025 May 1;43(5):814-821. doi: 10.1097/HJH.0000000000003977. Epub 2025 Feb 4.

DOI:10.1097/HJH.0000000000003977

PMID:39945743

Abstract

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.

摘要

背景与目的

代谢功能障碍相关脂肪性肝病（MASLD）是心血管疾病发病和死亡的独立危险因素。这些患者的另一个关键危险因素是动脉高血压（AH）。尽管据估计50%的MASLD患者患有AH，但作为诊断高血压金标准的24小时动态血压监测（24-h-ABPM）却常常被忽视。然而，只有24-h-ABPM能够识别高血压亚型，尤其是夜间高血压（NH），它比日间或24小时血压更能预测心血管死亡率。本研究的目的是调查MASLD患者中NH的患病率，并确定相关危险因素。

方法

为此，在门诊肝病科前瞻性招募了226例有或无已知AH的MASLD患者，他们接受了24-h-ABPM以及重复的诊室血压测量。

结果

最终分析纳入了218例患者的24-h-ABPM数据集。112例患者（51.3%）观察到NH，其中54例（48.2%）正在接受抗高血压治疗（未控制的高血压）。单变量回归分析显示，年龄、腰臀比增加、腰高比≥0.5、2型糖尿病（T2DM）、血脂异常、估计肾小球滤过率降低和肝硬度增加与NH风险较高显著相关。多变量回归分析中，T2DM[比值比（OR）2.56；95%置信区间（CI）1.09 - 6.23；P = 0.033]、血脂异常（OR 3.30；95% CI，1.67 - 6.73；P = 0.001）和肝硬度（OR 1.09；95% CI，1.02 - 1.18；P = 0.021）被确定为独立危险因素。