Assessing the value of liver fibrosis scores in hypertension: findings from a cross-sectional study

Background and purpose: Hypertension is the most significant modifiable risk factor for all-cause morbidity worldwide and is associated with an increased risk of cardiovascular disease. To alleviate the public health burden of hypertension, early identification of risk factors and preventive strategies is vital. Liver fibrosis scores (LFSs), which serve as non-invasive alternatives to liver biopsy, are commonly used to assess liver disease. Growing evidence demonstrated that liver disease may contribute to various systemic adverse effects, such as inflammation and activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, play a critical role in the pathophysiology of hypertension. This study aims to explore the relationship between LFSs and hypertension. Methods: A total of 11,503 participants from the Northeast China Rural Cardiovascular Health Study, which is a large prospective cross-sectional research consisting of a community all coming from rural areas, were included in this study. Four different LFSs were utilized: the aspartate aminotransferase (AST)/platelet ratio index (APRI); the BARD score (incorporating body mass index [BMI], AST/alanine aminotransferase [ALT] ratio, and diabetes status); the BAAT score (BMI, age, ALT, and triglycerides [TGs]); and the fibrosis-4 (FIB-4) index. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CI). Subgroup analysis was conducted to examine associations between LFSs and hypertension across different stratifications, while restricted cubic spline analysis demonstrated the linear correlation between LFSs and hypertension risk. The C statistic, net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to evaluate the impact of each LFS on hypertension risk prediction. Results: Baseline data identified that all four LFSs were higher among participants with hypertension. In multivariate logistic regression analysis, the OR for hypertension was as follows: 2.34 (95% CI: 1.95–2.81) for FIB-4, 1.34 (95% CI: 1.17–1.53) for the BARD score, 1.21 (95% CI: 1.03–1.43) for APRI, and last 1.21 (95% CI: 1.00–1.47) for the BAAT score, comparing high and low levels of each LFS. Adding LFSs to the original risk prediction model improved its predictive accuracy, with higher C -statistics and positive NRI and IDI values, indicating a significant enhancement in risk prediction for hypertension. Conclusion: This study demonstrates that LFSs are related to hypertension in individuals aged 35 and older in rural northeastern China.