Abstract
PURPOSE: Fatty liver disease (FLD) and hypertension (HTN) exhibit a bidirectional relationship: FLD elevates HTN risk, while HTN accelerates FLD progression to fibrosis. Research on this link is limited, with insulin resistance (IR) proposed as a key mechanism. The triglyceride-glucose-body mass index (TyG-BMI), an emerging IR marker, is poorly characterized regarding its association with FLD and HTN. This study assessed TyG-BMI's predictive value for HTN risk in FLD patients and its clinical significance. PATIENTS AND METHODS: A retrospective cohort of 6,257 FLD patients confirmed by ultrasonography from the Health Examination Center of Chengde Medical University was analyzed. Participants were categorized into FLD-HTN (n=2,804) and normotensive FLD (FLD-0, n=3,453) groups based on blood pressure measurements. Multivariable logistic regression models adjusted for confounders assessed TyG-BMI's independent association with HTN risk. Receiver operating characteristic (ROC) curve analysis, with DeLong's test, compared the discriminative ability of TyG-BMI against conventional indices (BMI and TyG index). Additionally, quartile-based stratification (Q1-Q4) further explored dose-response relationships. RESULTS: Multivariable-adjusted models showed a 1.6% increase in HTN risk for each unit increase in TyG-BMI (OR=1.016, 95% CI: 1.014-1.018, P < 0.001). A significant positive correlation was found between TyG-BMI and both systolic (r=0.264) and diastolic blood pressure (r=0.263, both P < 0.001). ROC curve analysis demonstrated that TyG-BMI (AUC=0.624) outperformed BMI (AUC=0.593) and the TyG index (AUC=0.603) (DeLong's test, P <0.01) in discriminating HTN risk. Notably, individuals in the highest TyG-BMI quartile (Q4) had a 3.38-fold higher risk of HTN compared to those in the lowest quartile (Q1) (OR=3.380, 95% CI: 2.842-4.020). CONCLUSION: TyG-BMI is a significant predictor of HTN risk in FLD patients, offering a clinically useful tool for targeted prevention strategies.