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Guzik BM, McCallum L, Zmudka K, Guzik TJ, Dominiczak AF, Padmanabhan S. Echocardiography Predictors of Survival in Hypertensive Patients With Left Ventricular Hypertrophy. Am J Hypertens 2021; 34:636-644. [PMID: 33950188 DOI: 10.1093/ajh/hpaa194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/07/2020] [Accepted: 03/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a well-known target organ damage. Concentric hypertrophy is the strongest predictor of increased risk of cardiovascular events, but the predictive value of individual echocardiographic parameters remains unclear.The aim of this study was to search for echocardiographic and hemodynamic variables associated with concentric and eccentric remodeling and their association with long-term cardiovascular outcomes. METHODS Patients with echocardiography performed within 1 year prior to the initial clinic visit were included into the study. Logistic regression and multivariable Cox-proportional hazards were calculated according to several risk factors and variables. Additionally, cubic spline interpolation was used. RESULTS We observed 690 patients for 10 years. There was a total of 177 major adverse cardiac and cerebrovascular events (MACCE) and 90 deaths over a 10-year period. Left ventricular concentric hypertrophy is associated with worse outcomes than eccentric hypertrophy in hypertensive subjects. Interestingly, different echocardiographic parameters contributed to risk depending on type of hypertrophy. In concentric hypertrophy, relative wall thickness provides linear prediction of risk for all-cause mortality (ACM) and composite endpoint. Systolic blood pressure is a significant predictor of MACCE. Blood pressure variability also showed significant predictive value for MACCE and ACM. CONCLUSIONS These data indicate risk stratification based on LVH need to consider different measures based on the type of remodeling.
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Affiliation(s)
- Bartlomiej M Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Krzysztof Zmudka
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Barbieri A, Albini A, Maisano A, De Mitri G, Camaioni G, Bonini N, Mantovani F, Boriani G. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Front Cardiovasc Med 2021; 8:667984. [PMID: 33987213 PMCID: PMC8110723 DOI: 10.3389/fcvm.2021.667984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Maisano
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gerardo De Mitri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Camaioni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Chen C, Ke L, Chan H, Chu C, Lee A, Lin K, Lee M, Hsiao P, Chen C, Shin S. Electronegative low-density lipoprotein of patients with metabolic syndrome induces pathogenesis of aorta through disruption of the stimulated by retinoic acid 6 cascade. J Diabetes Investig 2020; 11:535-544. [PMID: 31597015 PMCID: PMC7232312 DOI: 10.1111/jdi.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS/INTRODUCTION Electronegative low-density lipoprotein (L5) is the most atherogenic fraction of low-density lipoprotein and is elevated in people with metabolic syndrome (MetS), whereas the retinol-binding protein 4 receptor (stimulated by retinoic acid 6 [STRA6]) cascade is disrupted in various organs of patients with obesity-related diseases. Our objective was to investigate whether L5 from MetS patients capably induces pathogenesis of aorta through disrupting the STRA6 cascade. MATERIAL AND METHODS We examined the in vivo and in vitro effects of L5 on the STRA6 cascade and aortic atherogenic markers. To investigate the role of this cascade on atherosclerotic formation, crbp1 transfection was carried out in vitro. RESULTS This study shows that L5 activates atherogenic markers (p38 mitogen-activated protein kinases, pSmad2 and matrix metallopeptidase 9) and simultaneously suppresses STRA6 signals (STRA6, cellular retinol-binding protein 1, lecithin-retinol acyltransferase, retinoic acid receptor-α and retinoid X receptor-α) in aortas of L5-injected mice and L5-treated human aortic endothelial cell lines and human aortic smooth muscle cell lines. These L5-induced changes of the STRA6 cascade and atherogenic markers were reversed in aortas of LOX1-/- mice and in LOX1 ribonucleic acid-silenced human aortic endothelial cell lines and human aortic smooth muscle cell lines. Furthermore, crbp1 gene transfection reversed the disruption of the STRA6 cascade, the phosphorylation of p38 mitogen-activated protein kinases and Smad2, and the elevation of matrix metallopeptidase 9 in L5-treated human aortic endothelial cell lines. CONCLUSIONS This study shows that L5 from MetS patients induces atherogenic markers by disrupting STRA6 signaling. Suppression of STRA6 might be one novel pathogenesis of aorta in patients with MetS.
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Affiliation(s)
- Chao‐Hung Chen
- School of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Divison of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Liang‐Yin Ke
- Lipid Science and Aging Research CenterKaohsiung Medical UniversityKaohsiungTaiwan
- Department of Medical Laboratory Science and BiotechnologyCollege of Health SciencesKaohsiung Medical UniversityKaohsiungTaiwan
| | - Hua‐Chen Chan
- Department of Medical Laboratory Science and BiotechnologyCollege of Health SciencesKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chih‐Sheng Chu
- Division of CardiologyDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
| | - An‐Sheng Lee
- Department of MedicineMackay Medical CollegeNew TaipeiTaiwan
| | - Kun‐Der Lin
- School of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Divison of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
- Vascular and Medical ResearchTexas Heart InstituteHoustonTexasUSA
| | - Mei‐Yueh Lee
- School of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Divison of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Pi‐Jung Hsiao
- School of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Divison of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Chu‐Huang Chen
- Lipid Science and Aging Research CenterKaohsiung Medical UniversityKaohsiungTaiwan
- Vascular and Medical ResearchTexas Heart InstituteHoustonTexasUSA
- Department of Internal MedicineKaohsiung Ta‐Tung Municipal HospitalKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Shyi‐Jang Shin
- School of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Divison of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
- Department of Medical Laboratory Science and BiotechnologyCollege of Health SciencesKaohsiung Medical UniversityKaohsiungTaiwan
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Yu S, Chen Y, Yang H, Guo X, Zheng L, Sun Y. Hyperhomocysteinemia accompany with metabolic syndrome increase the risk of left ventricular hypertrophy in rural Chinese. BMC Cardiovasc Disord 2020; 20:44. [PMID: 32013876 PMCID: PMC6998833 DOI: 10.1186/s12872-020-01350-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/20/2020] [Indexed: 01/20/2023] Open
Abstract
Background To investigate the influence of hyperhomocysteinemia (HHcy) and metabolic syndrome (MetS) on left ventricular hypertrophy (LVH) in residents in rural Northeast China. Methods We performed a cross-sectional baseline data analysis of 6837 subjects (mean age: 54 ± 10 years) recruited from a rural area of China. Anthropometric indicators were measured according to standard methods. MetS was defined by the modified ATP III criteria. HHcy was defined according to the WHO standard: an Hcy level > 15 μmol/L representing HHcy. Four groups were defined: non-HHcy & non-MetS, HHcy & non-MetS, MetS & non-HHcy and HHcy & MetS. Results The left ventricular mass index for height2.7 (LVMH2.7) in both sexes was significantly higher in the HHcy & MetS group than in the non-HHcy & non-MetS group (females: 51.23 ± 16.34 vs. 40.09 ± 10.55 g-2.7, P < 0.001; males: 48.67 ± 12.24 g-2.7 vs. 42.42 ± 11.38 g-2.7, P < 0.001). A similar result was observed in those groups when using the left ventricular mass index (LVMI) for body surface area to define LVH (females: 103.58 ± 31.92 g− 2 vs. 86.63 ± 20.47 g− 2, P < 0.001; males: 106.10 ± 24.69 g− 2 vs. 98.16 ± 23.29 g− 2, P < 0.001). The results of multiple regression analysis indicated that the HHcy & MetS group had a higher risk of LVH than the other three groups (OR: 1.628 for LVMI, P < 0.001, OR: 2.433 for LVMH2.7, P < 0.001). Moreover, subjects in the HHcy & non-MetS group [OR (95% CI): 1.297 (1.058, 1.591) for LVMI, P < 0.05; OR (95% CI): 1.248 (1.044, 1.492) for LVMH2.7, P < 0.05] also had a statistically greater risk of LVH than subjects in the non-HHcy & non-MetS group. The HHcy & non-MetS group was also found to be significantly and independently associated with LVH. Conclusion Hyperhomocysteinemia has an independent effect on LVH. The combined effect of MetS and hyperhomocysteinemia might increase the strength of the abovementioned effects.
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Affiliation(s)
- Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Yintao Chen
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 117004, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.
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Refining the classification of left ventricular hypertrophy to provide new insights into the progression from hypertension to heart failure. Curr Opin Cardiol 2018; 31:387-93. [PMID: 27168169 DOI: 10.1097/hco.0000000000000299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Left ventricular hypertrophy (LVH), an important consequence of hypertension, is traditionally classified as either concentric or eccentric based on the presence or absence of increased relative wall thickness. In 2010, we proposed a novel four-tiered classification that accounted for LV dilatation in addition to LV wall thickness. The purpose of this review is to discuss the rationale for this revised classification and highlight subsequent studies that have assessed its utility. RECENT FINDINGS A series of recent observational studies have tested whether the four-tiered classification identifies subphenotypes of LVH with differential risk of adverse outcomes, including incident heart failure. The majority have confirmed that eccentric hypertrophy can be subdivided into a high-risk and a low-risk group based on whether LV dilatation is present. Additional studies have shown that LV dilatation is an independent risk factor for the development of heart failure. SUMMARY Incorporation of LV dilatation into the assessment of LVH identifies important subphenotypes within the standard two-tiered classification that have differential risk. Such refinements in the classification of LVH may yield new insights into how LVH progresses to heart failure, help identify risk factors for this transition, and improve therapeutic efforts to prevent its occurrence.
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Burroughs Peña M, Swett K, Schneiderman N, Spevack DM, Ponce SG, Talavera GA, Kansal MM, Daviglus ML, Cai J, Hurwitz BE, Llabre MM, Rodriguez CJ. Cardiac structure and function with and without metabolic syndrome: the Echocardiographic Study of Latinos (Echo-SOL). BMJ Open Diabetes Res Care 2018; 6:e000484. [PMID: 30116540 PMCID: PMC6091897 DOI: 10.1136/bmjdrc-2017-000484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE We assessed the hypothesis that metabolic syndrome is associated with adverse changes in cardiac structure and function in participants of the Echocardiographic Study of Latinos (Echo-SOL). METHODS Non-diabetic Echo-SOL participants were included in this cross-sectional analysis. Metabolic syndrome was defined according to the American Heart Association/National Heart, Lung, and Blood Institute 2009 Joint Scientific Statement. Survey multivariable linear regression analyses using sampling weights were used adjusting for multiple potential confounding variables. Additional analysis was stratified according to the presence/absence of obesity (body mass index (BMI) ≥25 kg/m2) and the presence/absence of metabolic syndrome. RESULTS Within Echo-SOL, 1260 individuals met inclusion criteria (59% female; mean age 55.2 years). Compared with individuals without metabolic syndrome, those with metabolic syndrome had lower medial and lateral E' velocities (-0.4 cm/s, (SE 0.1), p=0.0002; -0.5 cm/s (0.2), p=0.02, respectively), greater E/E' (0.5(0.2), p=0.01) and worse two-chamber left ventricular longitudinal strain (0.9%(0.3), p=0.009), after adjusting for potential confounding variables. Increased left ventricular mass index (9.8 g/m2 (1.9), p<0.0001 and 7.5 g/m2 (1.7), p<0.0001), left ventricular end-diastolic volume (11.1 mL (3.0), p=0.0003 and 13.3 mL (2.7), p<0.0001), left ventricular end-systolic volume (5.0 mL (1.4), p=0.0004 and 5.7 mL (1.3) p<0.0001) and left ventricular stroke volume (10.2 mL (1.8), p<0.0001 and 13.0 mL (2.0), p<0.0001) were observed in obese individuals with and without metabolic syndrome compared with individuals with normal weight without metabolic syndrome. In sensitivity analyses, individuals with normal weight (BMI <25 kg/m2) and metabolic syndrome had worse left ventricular global longitudinal strain (2.1%(0.7), p=0.002) and reduced left ventricular ejection fraction (-3.5%(1.4), p=0.007) compared with normal-weight individuals without metabolic syndrome. CONCLUSIONS In a sample of US Hispanics/Latinos metabolic syndrome was associated with worse left ventricular systolic and diastolic function. Adverse changes in left ventricular size and function were observed in obese individuals with and without metabolic syndrome but decreased left ventricular function was also present in normal-weight individuals with metabolic syndrome.
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Affiliation(s)
| | - Katrina Swett
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Neil Schneiderman
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Daniel M Spevack
- Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sonia G Ponce
- Department of Family and Preventive Medicine, University of California, San Diego, California, USA
| | - Gregory A Talavera
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Mayank M Kansal
- Division of Cardiology, University of Illinois, Chicago, Illinois, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois, Chapel Hill, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry E Hurwitz
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maria M Llabre
- Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Wang Y, Zeng Y, Lin C, Chen Z. Hypertension and non-alcoholic fatty liver disease proven by transient elastography. Hepatol Res 2016; 46:1304-1310. [PMID: 26932594 DOI: 10.1111/hepr.12688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 01/20/2016] [Accepted: 02/26/2016] [Indexed: 12/12/2022]
Abstract
AIM The relationship between non-alcoholic fatty liver disease (NAFLD) and hypertension is poorly understood. In the present study, we aimed to assess the relationship between essential hypertension and NAFLD, by using a new diagnostic tool, transient elastography (TE). METHODS We enrolled 836 subjects in this study. All subjects underwent a comprehensive questionnaire survey and blood test. Each patient had undergone TE to detect the controlled attenuation parameter, which was used to and quantify liver steatosis with the help of TE. RESULTS Participants with hypertension showed a higher prevalence of NAFLD defined by TE (P < 0.05). After adjusting for body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase, triglycerides, total cholesterol, and high-density lipoprotein cholesterol, the odds ratio for NAFLD, comparing the grade 3 group (systolic blood pressure level ≥ 180 mmHg and/or diastolic blood pressure level ≥ 110 mmHg) with the normal group, was 1.476 (95% confidence interval, 1.166-2.551). A stepwise multivariate linear regression analysis (R2 = 0.084, P = 0.043) retained NAFLD, BMI, and AST as significant predictors of the systolic blood pressure levels. Additionally, stepwise multivariate linear regression analysis (R2 = 0.199, P = 0.037) retained NAFLD, controlled attenuation parameter, BMI, triglycerides, and high-density lipoprotein cholesterol as significant predictors of diastolic blood pressure levels. In addition, BMI, AST, and alanine aminotransferase were associated with systolic blood pressure levels among individuals with NAFLD; BMI, AST, and total cholesterol were associated with diastolic blood pressure levels among individuals with NAFLD. CONCLUSION The main finding of our study is that hypertensive patients have a higher prevalence of NAFLD defined by TE, and NAFLD is independently associated with hypertension and blood pressure category.
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Affiliation(s)
- Yaohui Wang
- Department of Health Management Center, The Third XiangYa Hospital of Central South University, Changsha, Hunan, 410013, China
| | - Yuhua Zeng
- Department of Health Management Center, The Third XiangYa Hospital of Central South University, Changsha, Hunan, 410013, China
| | - Changwei Lin
- Department of General Surgery, The Third XiangYa Hospital of Central South University, Changsha, Hunan, 410013, China
| | - Zhiheng Chen
- Department of Health Management Center, The Third XiangYa Hospital of Central South University, Changsha, Hunan, 410013, China
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