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Association between hypertension and fatty liver index in patients undergoing coronary computed tomography angiography: a cross-sectional study

Hypertension Research volume 49, pages 526–538 (2026)Cite this article

Abstract

Fatty Liver Index (FLI) is associated with hypertension (HTN) in individuals undergoing general health screening and patients with hepatic steatosis; however, whether it is associated with HTN in patients undergoing coronary computed tomography angiography (CCTA) remains unclear. Therefore, to investigate this association, we conducted a cross-sectional study involving 1 173 patients with clinically suspected coronary artery disease. The primary outcomes of interest were FLI values and HTN prevalence. The mean FLI was 36.3 ± 25.8. Patients with HTN had a significantly higher FLI than those without HTN (39.1 ± 26.0 vs. 30.9 ± 24.7; P < 0.001). FLI was divided into three value-based categories, lower, intermediate, and higher; the HTN prevalence among them was 59.2%, 69.0%, and 75.6%, respectively, showing a significant linear trend (P < 0.001). A higher FLI was independently associated with HTN in a dose–response manner. Compared with the lower FLI group, the odds of HTN were greater in the intermediate (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.17–2.14, P = 0.003) and higher groups (OR: 2.59, 95% CI: 1.79–3.76, P < 0.001). Results were consistent in a sensitivity model treating FLI as continuous, each 10–unit increase in FLI was associated with 15.6% higher odds of HTN (OR: 1.16, 95% CI: 1.10–1.22, P < 0.001). Thus, FLI may serve as a valuable diagnostic indicator of HTN in patients undergoing CCTA, and incorporation of FLI assessment into routine CCTA evaluation protocols should be considered for more comprehensive cardiovascular risk assessment.

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Data supporting the findings of this study can be obtained from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for the English language editing and their assistance in creating the graphical abstract for this paper.

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Authors and Affiliations

  1. Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan

    Tetsuo Hirata, Yuhei Shiga, Kohei Tashiro, Sara Higashi, Tetsuro Tachibana, Yuto Kawahira, Yasunori Suematsu, Takashi Kuwano, Makoto Sugihara & Shin-ichiro Miura

Authors
  1. Tetsuo Hirata
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  2. Yuhei Shiga
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  3. Kohei Tashiro
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  4. Sara Higashi
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  5. Tetsuro Tachibana
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  7. Yasunori Suematsu
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  8. Takashi Kuwano
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Contributions

Conceptualization, YShi, KT, and SM; methodology, YShi, KT, and SM; software, TH; validation, YSu and TK; formal analysis, TH; investigation, TH, YShi, KT, and SM; resources, YShi, KT, SH, TT, and YK; data curation, YShi, KT, SH, TT, and YK; writing–original draft preparation, TH; writing–review and editing, SM; visualization, TH; supervision, MS, and SM; project administration, SM; funding acquisition, SM. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Shin-ichiro Miura.

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The authors declare no competing interests.

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of Fukuoka University (approval number: #09-10-02; October 28, 2009).

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All patients provided informed consent before participating in the study. Written informed consent was also obtained from the patients for publication of this paper.

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Hirata, T., Shiga, Y., Tashiro, K. et al. Association between hypertension and fatty liver index in patients undergoing coronary computed tomography angiography: a cross-sectional study. Hypertens Res 49, 526–538 (2026). https://doi.org/10.1038/s41440-025-02461-z

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