Abstract
Introduction. Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases; and considerable attention is paid to the comorbidity of NAFLD with hypertension (HT), which affects around one-third of the world's population. The combination of NAFLD with hypertension has been suggested to have a mutual potentiating effect, and hypertension affects the severity of NAFLD. The purpose: to study the features of the clinical manifestation of NAFLD in patients with hypertension. Materials and methods. The study included 115 patients with NAFLD at the stage of nonalcoholic steatohepatitis. The main group consisted of 63 patients with NAFLD and HT, the comparison group included 52 patients with isolated NAFLD, and the control group was composed of 20 healthy volunteers. The patients underwent anthropometric measurements, evaluation of biochemical markers of liver functional activity, lipid profile and carbohydrate metabolism changes, C-reactive protein (CRP) levels. Results. A significant increase in the proportion of patients with active complaints in the group of patients with NAFLD with HT (subjective signs of liver damage, manifestations of dyspeptic and asthenic syndrome) was detected. Significant differences were found in almost all anthropometric indicators in both groups of patients with NAFLD in comparison with the control group. The level of CRP had significant differences and was 7.90 mg/l (95% CI = 7.96-8.75 mg/l), 6.55 mg/l (95% CI = 6.47-7.57 mg/l) and 2.07 (95% CI = 1.83-2.85 mg/l) in patients with NAFLD and HT, isolated NAFLD and the control group, respectively (p <0.001). Fasting glucose levels were significantly higher in both groups of examined patients with NAFLD compared with controls. Significant differences were found in the levels of total cholesterol, VLDL cholesterol, HDL cholesterol and atherogenic factor in patients with NAFLD depending on concomitant HT. There was no significant difference between LDL cholesterol and triglycerides in the two groups of patients with NAFLD. Conclusions. Based on the obtained data, it can be stated that GC in patients with NAFLD determines important deviations in the clinical manifestation of the disease and can be considered as a trigger factor for the progression of NAFLD.
References
Ampuero, J., Aller, R., Gallego-Duran, R., Crespo, J., Calleja, J.L., Garcia-Monzon, C., … RomeroGomez, M. (2020). Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH. Journal of Hepatology, 73(1), 17–25. doi: 10.1016/j.jhep.2020.02.028.
Aneni, E. C., Oni, E. T., Martin, S. S., Blaha, M. J., Agatston, A. S., Feldman, T.,…Nasir K.(2015). Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk. Journal of Hypertension, 33(6), 1207–1214. doi: 10.1097/HJH.0000000000000532. PMID: 25693058.
Babak, O., Zajceva, M. (2018). Ocinjuvannja pokaznykiv kardiogemodynamiky u hvoryh na arterial'nu gipertenziju ta nealkogol'nu zhyrovu hvorobu pechinky zalezhno vid genotypiv polimorfizmu A1166S gena receptora angiotenzynu II pershogo typu [Assessment of cardiac hemodynamics indicators in patients with arterial hypertension and non-alcoholic fatty liver disease depending on angiotensin II type 1 receptor A1166C gene polymorphism]. Zaporozhskyj medycynskyj zhurnal, 20(3), 305–308.
Babak, O. Ya., Prosolenko, K. Î., Klimenko, Ì. I., Panchenko, G. Yu. (2020). Porivnjal'na harakterystyka shem tryvalogo kompleksnogo likuvannja hvoryh na nealkogol'nu zhyrovu hvorobu pechinky u pojednanni z gipertonichnoju hvoroboju [Comparative characteristics of long-term complex treatment regimens for patients with non-alcoholic fatty liver disease in combination with hypertension]. Ukrai'ns'kyj terapevtychnyj zhurnal, (1), 6–14. doi: 10.30978/UTJ2020-1-6.
Bonnet, F., Gastaldelli, A., Pihan-Le Bars, F., Natali, A., Roussel, R., Petrie J. (2017). Gammaglutamyltransferase, fatty liver index and hepatic insulin resistance are associated with incident hypertension in two longitudinal studies. Journal of Hypertension, 35, 493–500.
Fadjejenko, G. D., Kushnir, I. E., Chernova, V. M. (2018). Vzajemozv'jazok mizh rivnemsyrovatkovyh markeriv zapalennja ta metabolichnymy porushennjamy pry nealkogol'nij zhyrovij hvorobi pechinky [The relationship of serum inflammatory markers with metabolic disorders at the non-alcoholic fatty liver disease]. Suchasna gastroenterologija, 5(103), 7–12. doi: 10.30978/MG-2018-5-7.
Fracanzani, A. L., Petta, S., Lombardi, R., Pisano, G., Russello, M., Consonni, D., … Fargion, S.(2017). Liver and Cardiovascular Damage in Patients With Lean Nonalcoholic Fatty Liver Disease, and Association With Visceral Obesity. Clinical Gastroenterology and Hepatology, 15(10), 1604–1611. doi: 10.1016/j.cgh.2017.04.045.
Ilan, Y. (2018). Analogy between non-alcoholic steatohepatitis (NASH) and hypertension: a stepwisepatient-tailored approach for NASH treatment. Annals of gastroenterology, 31(3), 296–304.
Kim, M.J. Non-alcoholic Fatty Liver Disease, Cardio-metabolic Syndrome and Hypertension: OneConcept Fits Multi-systemic Presentations. (2020). Korean Circulation Journal, 50(8), 706–708. doi: 10.4070/kcj.2020.0217.
Liu, P., Tang, Y., Guo, X., Zhu, X., He, M., Yuan, J., … Yao, P. (2018). Bidirectional associationbetween nonalcoholic fatty liver disease and hypertension from the Dongfeng-Tongji cohort study. Journal of the American Society of Hypertension. doi: 10.1016 /j.jash.2018.06.013.
Lonardo, A., Ballestri, S., Marchesini, G., Angulo, P., Loria, P. (2015). Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 47, 181–190.
Lonardo, A., Nascimbeni, F., Mantovani, A., Targher, G. (2017). Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence? Journal of Hepatology, 68(2), 335-352. doi: 10.1016/j.jhep.2017.09.021. Epub 2017 Nov 6. PMID: 29122390.
Ma, J., Hwang, S.-J., Pedley, A., Massaro, J. M., Hoffmann, U., Chung, R. T., … Long, M. T. (2017). Bi-directional analysis between fatty liver and cardiovascular disease risk factors. Journal of
Hepatology, 66(2), 390–397. doi: 10.1016/j.jhep.2016.09.022.
Marunchyn, N., Dynnyk, O., Kovalerenko, L. (2017). Zastosuvannja pryncypu mul'typarametrychnogo ul'trazvuku dlja diagnostyky nealkogol'noi' zhyrovoi' hvoroby pechinky v pacijentiv iz cukrovym diabetom 2-go typu [Using the principle of multiparametric ultrasound for the diagnosis of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus]. Mezhdunarodnyi Endokrinologicheskii Zhurnal, no 13, pp.171–176. doi: 10.22141/2224-0721.13.2.2017.100608.
Oikonomou, D., Georgiopoulos, G., Katsi, V., Kourek, C., Tsioufis, C., Alexopoulou, A., Tousoulis, D. (2018). Non-alcoholic fatty liver disease and hypertension. European Journal of Gastroenterology & Hepatology, 30(9), 979–985. doi: 10.1097/meg.0000000000001191.
Singh, S., Allen, A.M., Wang, Z., Prokop, L.J., Murad, M.H., Loomba, R. (2015). Fibrosis progression in nonalcoholic fatty liver vs. nonalcoholic steatohepatitis: a systematic review and metaanalysis of paired-biopsy studies. Clinal Gastroenterology and Hepatology, 13, 643–654. doi: 10.1016/ j.cgh.2014.04.014.
Tiwari-Heckler, S., Gan-Schreier, H., Stremmel, W., Chamulitrat, W., Pathil, A. (2018). Circulating Phospholipid Patterns in NAFLD Patients Associated with a Combination of Metabolic Risk Factors. Nutrients, 10(5), 649. doi: 10.3390/nu10050649.
Tofano, R. J., Barbalho, S. M., Bechara, M. D., Quesada, K., Mendes, C. G., & Oshiiwa, M. (2017). Hypertension, C Reactive Protein and Metabolic Profile: What is the Scenario in Patients Undergoing Arteriography? Journal of clinical and diagnostic research, 11(8), BC19-BC23. https://doi.org/10.7860/JCDR/2017/26595.10456
Wu, S.-J., Zou, H., Zhu, G.-Q., Wang, L.-R., Zhang, Q., Shi, K.-Q., … Zheng, M.-H. (2015). Increased Levels of Systolic Blood Pressure Within the Normal Range Are Associated With Significantly Elevated Risks of Nonalcoholic Fatty Liver Disease. Medicine, 94(19), e842. doi: 10.1097/md.0000000000000842.
Younes, R., & Bugianesi, E. (2019). NASH in Lean Individuals. Seminars in Liver Disease, 39(1), 86–95. doi: 10.1055/s-0038-1677517.
Zhang, Y., Zhang, T., Zhang, C. (2015). Identification of reciprocal causality between non-alcoholic fatty liver disease and metabolic syndrome by a simplified Bayesian network in a Chinese population. The BMJ, 5, e008204. doi: 10.1136/bmjopen-2015-008204.
"Inter Collegas" is an open access journal: all articles are published in open access without an embargo period, under the terms of the CC BY-NC-SA (Creative Commons Attribution ‒ Noncommercial ‒ Share Alike) license; the content is available to all readers without registration from the moment of its publication. Electronic copies of the archive of journals are placed in the repositories of the KhNMU and V.I. Vernadsky National Library of Ukraine.