Circadian Blood Pressure Patterns in Adults with Moderate-to-Severe Hepatic Steatosis: A Prospective Ambulatory Blood Pressure Monitoring Study

Objective: Hepatic steatosis commonly coexists with cardiometabolic risk factors, yet circadian blood pressure patterns in adults with hepatic steatosis remain incompletely characterized. This study aimed to describe ambulatory blood pressure patterns in adults with ultrasonographically detected moderate-to-severe hepatic steatosis. Methods: This single-center prospective observational study enrolled adults with grade 2 or 3 hepatic steatosis on abdominal ultrasonography between August 2023 and August 2024. All participants underwent 24-h ambulatory blood pressure monitoring after enrollment. Patients were classified as dipper or non-dipper according to nocturnal blood pressure decline, and clinical, biochemical, ultrasonographic, and ambulatory parameters were compared. Results: Among 137 patients, 43 (31.4%) had a dipper pattern and 94 (68.6%) had a non-dipper pattern. Grade 2 and grade 3 steatosis were present in 125 (91.2%) and 12 (8.8%) patients, respectively. In the exploratory multivariable analysis, age, sex, antihypertensive treatment, and ultrasonographic steatosis grade were not independently associated with non-dipping status. Ambulatory hypertension thresholds were met more often in the non-dipper group [72 (76.6%) vs. 25 (58.1%), p = 0.027]. Nocturnal hypertension was more frequent in the non-dipper group [72 (76.6%) vs. 22 (51.2%), p = 0.003]. The non-dipper group had higher 24-h systolic blood pressure [134.0 (122.0–145.0) vs. 130.0 (118.5–136.0) mmHg, p = 0.027]. The median nocturnal systolic blood pressure decline in the overall cohort was 6.0% [2.6–11.3], whereas daytime systolic and diastolic blood pressure values were comparable between groups. Conclusions: Non-dipping blood pressure was frequent in adults with moderate-to-severe hepatic steatosis. Ambulatory blood pressure monitoring provides a descriptive assessment of nocturnal blood pressure patterns in this selected hepatic steatosis cohort.