Hypertension Linked to Liver Disease Progression and Adverse Outcomes in MASLD

A new multicenter analysis confirms that hypertension significantly increases the risk of disease progression and clinical complications in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

The study assessed 107,316 adults from the UK BioBank (UKBB), 8169 patients from the VCTE-Prognosis cohort, and 1670 individuals from the Paired Liver Biopsy cohort. Hypertension prevalence ranged from 33% to nearly 49% across these groups.

In the UKBB cohort, patients with MASLD and hypertension had a 30% higher risk of all-cause mortality, cardiovascular events, and liver-related outcomes compared to those without hypertension (adjusted HR = 1.30; 95% CI: 1.26–1.33; P < 0.001).

Liver disease progression was also significantly impacted. In the VCTE-Prognosis cohort, hypertension was associated with a 57% increased risk of liver stiffness progression (adjusted HR = 1.57; 95% CI: 1.30–1.90; P < 0.001), while in the biopsy cohort, it was linked to a 41% higher risk of histologic fibrosis progression (adjusted HR = 1.41; 95% CI: 1.12–1.78; P = 0.004).

“Hypertension is a modifiable risk factor and increases risk of adverse clinical outcomes and progression of liver stiffness/fibrosis,” the authors stated.

These findings reinforce the importance of systematically assessing and managing hypertension in patients with MASLD. The data support integrating blood pressure control as part of a comprehensive approach to slow hepatic disease progression and reduce overall morbidity and mortality in this population.

Reference
Zhou XD, Lian L, Chen QF, et al. Effect of hypertension on long-term adverse clinical outcomes and liver fibrosis progression in MASLD. J Hepatol. Published online August 23, 2025. doi:10.1016/j.jhep.2025.08.017