Abstract: Objective To investigate the effect of interaction between hypertension and type 2 diabetes mellitus (T2DM) on the risk of liver fibrosis in MASLD, and to provide reference for scientific and reasonable prevention or delay of liver fibrosis in MASLD. Methods The clinical data of 733 inpatients in the Department of Hepatology, Xinjiang Medical University affiliated Traditional Chinese Medicine from January 2018 to June 2024 were collected. The patients were divided into MASLD group and MASLD with liver fibrosis group according to whether they were complicated with liver fibrosis. The baseline data of the two groups were compared. The effects of hypertension and type 2 diabetes on the risk of liver fibrosis in MASLD were analysed by binary logistic regression model. The interaction between hypertension and type 2 diabetes was analysed using a multiplicative and additive model. The relative excess risk (RERI), interaction attribution ratio (API) and interaction index (SI) were calculated. Results Compared with the MASLD group, the MASLD with liver fibrosis group had a higher proportion of hypertension, hyperuricemia and T2DM, which were 43.4%, 72.5% and 25.5% respectively. The levels of TG and CAP were also higher, at 1.91 (1.36, 2.74) mmol/L and (278.73±31.78) dB/m, respectively.The risk of MASLD-related liver fibrosis in patients with hypertension and T2DM was 24.43 times higher than that of those without hypertension and T2DM (OR=24.35, 95%CI:4.82~122.95, P<0.05). There was an additive interaction between hypertension and T2DM(RERI=13.07,95%CI:2.42~60.29,SI=8.06,95%CI:6.26~16.07,API=0.82,95%CI:0.62~0.92). Conclusion There may be an additive interaction between hypertension and T2DM. Maintaining blood pressure and blood glucose at normal levels may collaboratively prevent or delay liver fibrosis in MASLD.

Key words: Hypertension, Type 2 diabetes, Metabolic dysfunction-associated steatotic liver disease, Hepatic fibrosis, Interaction