Bi-directional and temporal relationship between elevated alanine aminotransferase and hypertension in a longitudinal study of Chinese adults

ABSTRACT

Objective

Despite the strong correlation between elevated alanine aminotransferase (ALT) and hypertension, their bi-directional and temporal relationship are currently unclear. Our study aimed to explore the bi-directional and temporal association between elevated ALT (ALT > 40 U/L) and hypertension.

Methods

Measurements of alanine aminotransferase and blood pressure were obtained twice from 2013 to 2017 in 3314 Chinese adults without cardiovascular disease at baseline. Bi-directional and cross-lagged panel analyses were performed to dissect the temporal relationship between elevated ALT and hypertension.

Results

Longitudinally, we found that baseline elevated ALT was strongly correlated with incident hypertension (odds ratios = 2.16, P = .001), and baseline hypertension was also significantly associated with incident elevated ALT (odds ratios = 1.64, P = .026). The cross-lagged path coefficients from baseline ALT to follow-up blood pressure were significantly greater than that from baseline blood pressure to follow-up ALT (β: 0.043 vs. 0.026, P < .05 for systolic blood pressure and β: 0.052 vs. 0.024, P < .05 for diastolic blood pressure).

Conclusion

Our results provide evidence for the bi-directional association of elevated ALT and hypertension among Chinese adults, and elevated ALT probably antedates the development of hypertension.

KEYWORDS:

• Bi-directional association
• temporal sequence
• alanine aminotransferase
• hypertension

Disclosure statement

There are no conflicts of interest.

Author contributions

All authors contributed to the findings of the study. Guoxin Huang and Hui Zhou wrote the manuscript of the study; Chao Shen, Yihui Sheng and Ruyu Xue were involved in the data analysis; Chen Dong engaged in the whole process of the study; Shaoyan Zhang designed the research, performed the data analysis, and revised the manuscript.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (NSFC) [Grant Nos. 81773509 and 81773507], Suzhou Key technologies of prevention and control of major diseases and infectious diseases [Gwzx201804] and partially supported as a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD) in China.