Study Finds NAFLD Severity Correlated with Hypertension Risk

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Hypertension prevalence was significantly higher among adults with obesity and severe NAFLD, providing important information related to the association between hypertension and NAFLD severity.

Results of a cross-sectional study of more than 200 adults suggest increased severity of non-alcoholic fatty liver disease (NAFLD) was linked to an increased prevalence of hypertension.

With limited information surrounding NAFLD severity and hypertension, results of the study provide new insight into the association for clinicians, with further analysis suggesting this association between hypertension and severe NAFLD in adults with obesity was strongest in those without metabolic syndrome (MetS).

“The information is still limited regarding NAFLD severity and its linkage with hypertension. For example, previous research only studied Asian and European populations with small sample sizes. Likewise, it did not use biopsy (the gold standard) for the diagnosis of NAFLD, which may provide more accurate results. Therefore, this study aimed to assess the association between hypertension and the severity of biopsy-proven NAFLD in adults with obesity,” wrote investigators.1

NAFLD affects approximately 25% of people worldwide. Up to 75% of people who have obesity or diabetes and about 90% of people with class III obesity (BMI > 40) have NAFLD.2 Recognized by the US Centers for Disease Control and Prevention as health conditions associated with increased risk of hypertension, a greater understanding of the association between NAFLD severity and hypertension could have a significant benefit on patient care.3

Led by Carlos Toro-Huamanchumo, MD, Research Associate at Universidad San Ignacio de Loyola, the current study was designed as a cross-sectional analysis of data from a private bariatric center in Peru with the intent of estimating the association between hypertension and patients with obesity and severe NAFLD. Overall, the analysis included 239 patients aged 18 to 59 years with a BMI of 30 kg/m2 or greater, and biopsy-proven NAFLD.1

For the purpose of analysis, investigators evaluated the severity of NAFLD based on patients’ liver biopsies using the Fatty Liver Inhibition of Progression algorithm / Steatosis, Activity and Fibrosis score (FLIP/SAF). Investigators pointed out hypertension was defined as a having a mean systolic blood pressure (SBP) of 140 mmHg or greater or diastolic pressure (DBP) of 90 mmHg or greater.1

Investigators used Poisson generalized linear models with logarithmic link function and robust variances to calculate crude and adjusted prevalence ratios (aPR). Investigators noted multivariable models used in the study were adjusted for age, sex, physical activity, and smoking.1

Initial analysis revealed the prevalence of hypertension and severe NAFLD among the study cohort were 19.2% and 53.8%, respectively. The prevalence of metabolic syndrome was 56.4%. Investigators highlighted a significantly higher frequency of hypertension in participants with severe NAFLD compared to non-severe NAFLD (24.6% vs 13.0%; P = .024).1

Further analysis identified an association between hypertension and severe NAFLD in adults with obesity (aPR,1.33; 95% confidence interval [CI]: 1.03–1.74). Investigators called specific attention to results suggesting this association remained significant only in the absence of MetS (aPR, 1.80; 95% CI: 1.05–3.11).1

“An association between hypertension and NAFLD severity means that clinicians should boost the healthcare of hypertensive patients with NAFLD. Better care includes a better monitoring of hypertension and NAFLD and a more aggressive change of harmful habits that influence NAFLD progression,” concluded investigators.1


  1. Chambergo-Michilot D, Rodrigo-Gallardo PK, Huaman MR, et al. Hypertension and Histopathology Severity of Non-Alcoholic Fatty Liver Disease Among Adults with Obesity: A Cross-Sectional Study. Clin Exp Gastroenterol. 2023;16:129-136. Published 2023 Aug 14. doi:10.2147/CEG.S402498
  2. Non-alcohol related fatty liver disease (NAFLD): What it is, treatment & causes. Cleveland Clinic.
  3. High blood pressure symptoms and causes. Centers for Disease Control and Prevention. May 18, 2021.,for%20developing%20high%20blood%20pressure.