Fatty Liver and High Blood Pressure: What’s the Link?
Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with high blood pressure, or hypertension, but the cause-effect relationship between the two conditions is unclear. This condition used to be known as non-alcoholic steatotic liver disease (NAFLD). Steatosis means a buildup of fat in an organ — in this case, the liver.
Does too much fat in your liver cause high blood pressure? Or does high blood pressure cause fatty liver disease? More research is needed to answer those questions for sure.
But numerous studies have confirmed that the association goes both ways — the two conditions contribute to each other. If you have high blood pressure, you’re more likely to have MASLD, and if you have MASLD, you’re more likely to have high blood pressure.
It’s unclear what exactly links MASLD to high blood pressure. But research suggests that the link may be:
- Systemic inflammation. MASLD can cause inflammation, which can over-activate your body’s sympathetic nervous system and lead to high blood pressure.
- Insulin resistance, which is when your body doesn’t respond the way it should to the hormone insulin. Fatty liver disease and high blood pressure often coexist, and both are linked to insulin resistance.
- Oxidative stress, which is when there’s an imbalance between free radicals (unstable molecules that can damage cells) and antioxidants (which counteract the free radicals) in your body. Fatty liver can increase oxidative stress throughout the body, and that can contribute to hypertension.
- Vasoconstriction is when your blood vessels constrict or tighten. Fatty liver can throw off the hormones that help regulate blood vessel constriction. This can then raise your blood pressure because the constricted blood vessels require more pressure for blood to travel through them.
Along with these potential links, fatty liver disease and high blood pressure also share some of the same risk factors. These include high cholesterol, diabetes, and obesity. Many of these conditions and diseases overlap.
How common is high blood pressure in those with fatty liver disease?
Up to 40% of people with MASLD are estimated to have high blood pressure. Another estimate says that about 50% of people with hypertension also have fatty liver. This matters because if you have both conditions, your risk of death and serious complications is higher.
One study found that 46% of the respondents with fatty liver disease also had high blood pressure. And when participants had both conditions, they had an increased risk of death from cardiovascular disease and from other causes.
Also, your risk of atherosclerosis, when your arteries harden, may be much higher if you have both conditions. A study found that when participants had both fatty liver and high blood pressure, their risk of atherosclerosis was significantly higher than it would be with only one of these conditions.
Fatty liver severity and high blood pressure
More severe fatty liver disease may be worse for your blood pressure. Research suggests that increased liver fat may raise your risk of hypertension and that improving liver health may reduce your risk of developing hypertension.
But the severity of high blood pressure may also make a difference. One study compared patients with fatty liver disease and uncontrolled high blood pressure with those who had fatty liver and controlled high blood pressure. It found that the people with uncontrolled high blood pressure had a significantly greater risk of death than those with controlled high blood pressure did.
Obesity, fatty liver, and high blood pressure
Obesity is a cause of MASLD, and it’s considered a risk factor for both fatty liver and high blood pressure. Among people with obesity, fatty liver is common — an estimated 50% to 90% have MASLD.
Fatty liver disease is associated with metabolic syndrome, which sometimes involves both obesity and high blood pressure. Metabolic syndrome is a cluster of conditions that includes abdominal obesity, high blood pressure, high blood sugar levels, high blood triglycerides, and low HDL cholesterol. People with metabolic syndrome have at least three of these five conditions.
How to Manage High Blood Pressure and Fatty Liver
Just as the risk factors for fatty liver and high blood pressure overlap, ways to manage these two conditions also overlap. These three lifestyle changes can help manage fatty liver disease and high blood pressure:
- Eat a healthy, calorie-controlled diet, including fruits and vegetables, lean protein, and whole grains. Limiting red meats and sugary drinks can help. Foods that are high in simple carbohydrates and saturated fats are more likely to promote fatty liver.
- If you’re overweight, lose excess weight. Reducing the calories you eat each day and exercising may help you do this.
- Exercise regularly. Try to get at least 150 minutes of physical activity per week. But if you don’t already have an exercise routine, talk to your doctor before getting started.
Treatment for fatty liver typically focuses on these lifestyle changes. But here are some other things that can help manage both high blood pressure and fatty liver:
- Lowering your cholesterol
- Avoiding alcohol because it causes fat to accumulate in the liver
- If you have diabetes, keeping your diabetes under control
There is no approved medication for fatty liver disease. But for people whose fatty liver disease has progressed to a more serious condition called metabolic dysfunction-associated steatohepatitis (MASH), the FDA has approved the drug Rezdiffra (resmetirom). It’s prescribed along with a healthy diet and exercise.
What Happens When High Blood Pressure and Fatty Liver Go Untreated?
If fatty liver disease goes untreated, it can become cirrhosis of the liver, meaning healthy liver tissue is replaced by scar tissue, which can build up and prevent your liver from working properly. If it progresses, cirrhosis can lead to liver failure, liver cancer, and cancer elsewhere in the body.
People with MASLD have a higher risk of heart disease, too. And heart disease is the leading cause of death in people with fatty liver.
If high blood pressure goes untreated, it can cause damage to different parts of your body, including your heart, arteries, and brain. It can cause life-threatening complications, including heart attack and stroke.
Both fatty liver disease and high blood pressure can lead to death, through heart problems and other complications. So it’s important to get treatment and find out how to manage these conditions.
Takeaways
MASLD is connected to high blood pressure, and they contribute to each other. But what exactly links these two conditions to each other remains uncertain. They share some of the same risk factors, as well as some of the same management strategies, like eating a healthy diet, exercising regularly, and losing weight. People who have both fatty liver disease and high blood pressure have a heightened risk of serious complications, so it’s important to get treatment.
Fatty Liver and Blood Pressure FAQs
Can fatty liver raise your blood pressure?
It’s unclear whether MASLD causes high blood pressure — or vice versa. But fatty liver is one thing that is known to contribute to high blood pressure.
What blood pressure medication is good for fatty liver?
Blood pressure medications aren’t approved to treat fatty liver disease, but research suggests that some blood pressure medications, such as losartan, may also help treat fatty liver. But more research is needed, and research on other drugs is under way as well.
What other liver problems cause high blood pressure?
Cirrhosis of the liver, when your liver is scarred and damaged, can cause a type of high blood pressure called portal hypertension. With this condition, the scar tissue in your liver compresses the blood vessels that run through it, reducing blood flow.
Does everyone with fatty liver have high blood pressure?
No, not everyone with fatty liver has high blood pressure. But many people do. According to one estimate, up to 40% of people with MASLD also have high blood pressure.
What’s considered high blood pressure?
Generally, high blood pressure is considered 130/80 or higher. Blood pressure of 120/80 or lower is considered normal.
