Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO

Abstract

Hypertensive urgencies (HU) and hypertensive emergencies (HE) are challenges for the Emergency Department (ED). A prospective multicentre study is ongoing to characterize patients with acute hypertensive disorders, prevalence of subclinical hypertension-mediated organ damage (HMOD), short- and long-term prognosis; this is a preliminary report. Patients admitted to the ED with symptomatic blood pressure (BP) ≥180/110 mmHg were enrolled. They were managed by ED personnel according to their clinical presentations. Subsequently they underwent clinical evaluation and subclinical HMOD assessment at a Hypertension Centre within 72 h from enrolment. 122 patients were included in this report. Mean age was 60.7±13.9 years, 52.5% were females. 18 (14.8%) patients were diagnosed with HE, 108 (88.5%) with HU. There were no differences in gender, BMI, and cardiovascular comorbidities between groups. At ED discharge, 66.7% and 93.6% ( p = 0.003) of HE and HU patients, respectively, had BP < 180/110 mmHg. After 72 h, 34.4% of patients resulted normotensive; 35.2%, 22.1%, and 8.2% had hypertension grade 1, 2, and 3, respectively. Patients with uncontrolled BP at office evaluation had higher vascular HMOD (49.1 vs. 25.9%, p = 0.045). Cardiac (60 vs. 34%, p = 0.049), renal (27.8 vs. 9.6%, p = 0.010) and cerebral (100 vs. 21%, p < 0.001) HMOD was more frequent in HE compared to HU group. HE showed greater cardiac, renal, and cerebral subclinical HMOD, compared to HU. 72-hours BP control is not associated with different HMOD, except for vascular HMOD; therefore, proper comprehensive examination after discharge from the ED could provide added value in cardiovascular risk stratification of such patients. One third of patients with acute blood pressure rise evaluated to the ED resulted normotensive at office evaluation (<72 hours after discharge). Patients with hypertensive emergency showed greater cardiac, renal, and cerebral subclinical HMOD, compared to the patients with hypertensive urgency. BP: blood pressure; HMOD: hypertension-mediated organ damage; y.o.: years old; mo.: months.

Cardiac Morphology, Function, and Left Ventricular Geometric Pattern in Patients with Hypertensive Crisis: A Cardiovascular Magnetic Resonance-Based Study

“…Generally, LV systolic function, determined via an ejection fraction, is preserved in patients with HHD and hypertensive crisis, and only begins to deteriorate under late-stage disease [ 5 , 14 ]. We found impaired LV systolic function in 46% of all hypertensive crises that mainly involved patients with hypertensive emergency, which is higher than what was reported in other studies [ 29 , 30 ]. However, Gosse et al reported impaired systolic function using global longitudinal strain measured via echocardiography in 53% of patients with acute phase malignant hypertension [ 15 ].…”

“…The prevalence of LVH in hypertensive emergency in our study is comparable to what was reported by Rubin et al in their cohort of malignant hypertension [ 29 ]. However, the ERIDANO study reported LVH in 34% of their cohort with hypertensive crisis [ 30 ]. This discrepancy may be related to differences in the study populations.…”

The Role of Cardiac Biomarkers in the Diagnosis of Hypertensive Emergency

“…The combination of LDH with NT-proBNP did not perform differently from LDH. Our cohort of hypertensive crisis are younger, with comparable age in hypertensive emergency and urgency compared to reports from other studies [11][12][13]. Acute pulmonary edema, neurological emergencies, and acute coronary syndrome dominated the acute hypertension-mediated organ damage, similar to most studies [4,12,13].…”

The Role of Cardiac Biomarkers in the Diagnosis of Hypertensive Emergency

“…Our cohort of hypertensive crisis are younger, with comparable age in hypertensive emergency and urgency compared to reports from other studies [11][12][13]. Acute pulmonary edema, neurological emergencies, and acute coronary syndrome dominated the acute hypertension-mediated organ damage, similar to most studies [4,12,13].…”