Management of hypertension and dyslipidaemia in NAFLD
| Risk factor | Treatment/indication | Outcome |
|---|---|---|
| Hypertension | ACEI and ARBs first-line if BP >140/90 mm Hg61 | Blocking RAS reduces hepatic fibrosis62 63 |
| Escalate treatment according to NICE hypertension guidelines | ARBs improve transaminase levels and insulin sensitivity64 | |
| 20% reduction in new onset T2DM with ACEI or ARBs65 | ||
| Dyslipidaemia | Primary prevention with statin if ≥20% 10-year risk of developing cardiovascular disease66 | Statins 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.