Cardiovascular Effects of Intensive BP Control in Patients With and Without MAFLD

Overview

This post hoc analysis of the CRHCP trial evaluated the cardiovascular benefits and safety of intensive blood pressure (BP) management targeting <130/80 mmHg in individuals with metabolic dysfunction-associated fatty liver disease (MAFLD) compared to those without MAFLD. The study found that intensive BP control significantly reduced cardiovascular events in both populations, providing preliminary evidence to guide BP management in this high-risk group.

Background

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects nearly 30% of the global population and is strongly linked to increased cardiovascular disease (CVD) risk, which is the leading cause of death in this group. The 2020 redefinition from NAFLD to MAFLD emphasizes inclusion criteria based on metabolic abnormalities, but current hypertension guidelines lack specific BP management recommendations for MAFLD patients. Intensive BP control has proven effective in reducing cardiovascular events in general hypertensive populations, yet its efficacy and safety in MAFLD remain understudied. This analysis addresses this gap by examining outcomes from the CRHCP trial in patients with and without MAFLD.

Data Highlights

Key Findings

• Intensive BP control targeting <130/80 mmHg was implemented by trained non-physician community healthcare providers under physician supervision.
• Among 12,912 patients with MAFLD, intensive BP management significantly reduced cardiovascular events compared to usual care.
• Similar cardiovascular benefits were observed in 16,712 patients without MAFLD, indicating broad efficacy of intensive BP control.
• No major safety concerns were reported with intensive BP lowering in the MAFLD population during the 4-year follow-up.
• The study highlights the metabolic and inflammatory characteristics of MAFLD that may influence cardiovascular risk and treatment response.

Clinical Implications

These findings support the application of intensive blood pressure control strategies in patients with MAFLD to reduce cardiovascular risk, aligning with evidence from general hypertensive populations. Clinicians should consider targeting BP <130/80 mmHg in MAFLD patients while monitoring for safety. Further prospective trials are needed to refine guidelines and optimize cardiovascular prevention in this metabolically vulnerable group.

Conclusion

Intensive blood pressure management effectively reduces cardiovascular events in individuals with and without MAFLD, providing important preliminary evidence to inform clinical practice. This analysis underscores the need for disease-specific hypertension guidelines incorporating MAFLD considerations.

References

1. CRHCP Study Group 2023 -- Cardiovascular Effects of Aggressive Blood Pressure Management in Individuals With and Without MAFLD