Table 3

Management of hypertension and dyslipidaemia in NAFLD

Risk factorTreatment/indicationOutcome
HypertensionACEI and ARBs first-line if BP >140/90 mm Hg61Blocking RAS reduces hepatic fibrosis62 63
Escalate treatment according to NICE hypertension guidelinesARBs improve transaminase levels and insulin sensitivity64
20% reduction in new onset T2DM with ACEI or ARBs65
DyslipidaemiaPrimary prevention with statin if ≥20% 10-year risk of developing cardiovascular disease66Statins reduce 5-year incidence of all-cause mortality, major coronary events, coronary revascularisation and stroke by about 20% per mmol/L reduction in LDL cholesterol67
If secondary prevention, aim total cholesterol <4 mmol/L
May reduce incidence of HCC69
  • ACEI, ACE inhibitor; ARB, angiotensin receptor blocker; BP, blood pressure; HCC, hepatocellular carcinoma; LDL, low-density lipoprotein; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; T2DM, type 2 diabetes mellitus; RAS, renin–angiotensin system.