Prevalence and Treatment of Arterial Hypertension Among Patients with Biopsy-Proven Non-Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in western countries with a prevalence of 20-30 %, mainly affecting middle-aged men. NAFLD is considered as part of the metabolic syndrome and is associated with an increased cardiovascular morbidity and mortality. The aim of our study was to determine the prevalence of arterial hypertension and treatment modalities in patients with NAFLD. Methods: Among 1880 patients with documented liver biopsies who were seen between 1998 and 2005 at the Clinic for Gastroenterology and Hepatology at the Abdominal Center of the University of Cologne, 144 patients with biopsyproven NAFLD, i. e. 37 patients with non-alcoholic fatty liver (NAFL) and 107 patients with non-alcoholic steatohepatitis (NASH), were retrospectively analyzed for the following features: age, gender, degree of liver fibrosis, obesity, arterial hypertension, diabetes mellitus type 2, dyslipoproteinemia, metabolic syndrome, and frequency and type of antihypertensive medication. Data from patients with a chronic hepatitis C virus infection (n = 766) served as control. Results: Both patient groups showed a similar gender ratio with male predominance and comparable mean age. NASH patients had a higher Body Mass Index (p = 0.015) and suffered more often from diabetes mellitus type 2 (p = 0.035) compared to NAFL patients. There was only a trend towards an increased rate of metabolic syndrome or arterial hypertension in NASH patients. However, the prevalence of arterial hypertension was 3 times higher in NAFLD patients (28.9 %) than in the control group (9.3 %) but below that expected for the general population. Only 50 % of patients diagnosed with arterial hypertension received antihypertensive treatment, and inhibitors of the renin-angiotensin-aldosterone system were the most frequently prescribed drugs. Conclusion: In consideration of the increased cardiovascular risk of patients with NAFLD the atherogenic risk profile should be recorded and tried to improve by means of lifestyle changes and intensified blood pressure control with antihypertensive drugs free of unfavourable metabolic effects.