NAFLD; Hypertension, White-coat Hypertension, Masked Hypertension Clinical Trial
Official title:
24-h-ambulatory Blood Pressure Monitoring (24-h-ABPM) and Pulse Wave Analysis (PWA) in Patients With Non-alcoholic Fatty Liver Disease (NAFLD) to Evaluate the Individual Cardiovascular Risk Profile.
Evaluation of the individual cardiovascular risk profile of patients with non-alcoholic fatty liver disease (NAFLD) using 24-hour ambulatory long-term blood pressure measurement and pulse wave analysis
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in western
industrialized countries. Globally, but also in Germany, the current prevalence of NAFLD in
the adult population is about 20-30% with a continuing upward trend.
The main cause of death in patients with NAFLD include cardiovascular events and the major
risk factor for the occurrence of cardiovascular events is arterial hypertension.
Besides absolute systolic and diastolic blood pressure values, disturbances of circadian
blood pressure variability seem to be of particular relevance for the occurrence of
cardiovascular events.
24-hour ambulatory blood pressure monitoring (24-h-ABPM) has been established as the most
reliable, non-invasive method to diagnose arterial hypertension. 24-h-ABPM complements office
blood pressure measurement by the option of characterizing the circadian blood pressure
profile and is superior to it in terms of predicting total mortality and cardiovascular
mortality. Under- or overestimation of the actual blood pressure level during individual
measurements in everyday clinical practice can be avoided by using 24-h-ABPM and special
hypertension phenotypes such as white coat hypertension or masked hypertension can be
identified.
In addition, modern 24-h-ABPM devices allow a simultaneous pulse wave analysis (PWA) to
evaluate central hemodynamic parameters such as central aortic blood pressure, systolic blood
pressure augmentation and pulse wave velocity. Using these functional parameters of pulsatile
hemodynamics, it is possible to determine the extent of vascular damage and the
cardiovascular risk of the individual patient much earlier and more precisely.
Although the epidemiological relationship between hypertension and cardiovascular morbidity
and mortality in patients with NAFLD is well known, arterial hypertension and its special
subtypes are still under- or misdiagnosed in this risk group or not sufficiently controlled
when diagnosis has been established.
In this study we analyse the frequency of arterial hypertension and associated special
subtypes (masked hypertension, white-coat hypertension) and altered functional hemodynamics
in NAFLD patients using 24-h-ABPM and PWA. In addition we analyse serological biomarkerst to
evaluate the individual cardiovascualr risk profile. Healthy persons without NAFLD as well as
patients with other chronic liver diseases serve as controll and comparison group,
respectiveley.
After successful characterization of the patient-specific cardiovascular risk profile, the
development and establishment of a multimodal prevention program for NAFLD patients is
planned. Central aspects of this interdisciplinary concept include counseling and guidance on
lifestyle modifications (weight reduction, increase of physical activity, etc.) and
optimization of the adjustment of cardiometabolic comorbidities (especially diabetes mellitus
type 2, lipid metabolism disorders).
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