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Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO.
Hypertens Res. 2023 06; 46(6):1570-1581.HR

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.

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Authors+Show Affiliations

Vallelonga F
Division of Internal Medicine, Hypertension Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy. vallelonga.fabrizio@gmail.com.
Cesareo M
Division of Internal Medicine, Hypertension Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Menon L
Division of Internal Medicine, Hypertension Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Leone D
Division of Internal Medicine, Hypertension Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Lupia E
Emergency Medicine Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Morello F
Emergency Medicine Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Totaro S
Emergency Medicine Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Aggiusti C
Department of Internal Medicine, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
Salvetti M
Department of Internal Medicine, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
Ioverno A
Clinic of Emergency Medicine, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Maloberti A
Cardiothoracovascular Department, Cardiology 4 Unit, Grande Ospedale Metropolitano Niguarda Ca Granda, University of Milan-Bicocca, Milan, Italy.
Fucile I
Department of Advanced Biomedical Science, Hypertension Research Center, "Federico II" University Hospital of Naples, Naples, Italy.
Cipollini F
Department of Medical Specialties, AUSL Toscana Centro, Internal Medicine Unit, San Marcello e San Jacopo I Hospital, Pistoia, Italy.
Nesti N
Department of Medical Specialties, AUSL Toscana Centro, Internal Medicine Unit, San Marcello e San Jacopo I Hospital, Pistoia, Italy.
Mancusi C
Department of Advanced Biomedical Science, Hypertension Research Center, "Federico II" University Hospital of Naples, Naples, Italy.
Pende A
Clinic of Emergency Medicine, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Giannattasio C
Cardiothoracovascular Department, Cardiology 4 Unit, Grande Ospedale Metropolitano Niguarda Ca Granda, University of Milan-Bicocca, Milan, Italy.
Muiesan ML
Department of Internal Medicine, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
Milan A
Division of Internal Medicine, Hypertension Unit, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.

MeSH

FemaleHumansMiddle AgedAgedMaleEmergenciesProspective StudiesHypertensionBlood PressureHypertension, MalignantItaly

Pub Type(s)

Multicenter Study
Journal Article

Language

eng

PubMed ID

36805031

Citation

Vallelonga, Fabrizio, et al. "Hypertensive Emergencies and Urgencies: a Preliminary Report of the Ongoing Italian Multicentric Study ERIDANO." Hypertension Research : Official Journal of the Japanese Society of Hypertension, vol. 46, no. 6, 2023, pp. 1570-1581.
Vallelonga F, Cesareo M, Menon L, et al. Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO. Hypertens Res. 2023;46(6):1570-1581.
Vallelonga, F., Cesareo, M., Menon, L., Leone, D., Lupia, E., Morello, F., Totaro, S., Aggiusti, C., Salvetti, M., Ioverno, A., Maloberti, A., Fucile, I., Cipollini, F., Nesti, N., Mancusi, C., Pende, A., Giannattasio, C., Muiesan, M. L., & Milan, A. (2023). Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO. Hypertension Research : Official Journal of the Japanese Society of Hypertension, 46(6), 1570-1581. https://doi.org/10.1038/s41440-023-01232-y
Vallelonga F, et al. Hypertensive Emergencies and Urgencies: a Preliminary Report of the Ongoing Italian Multicentric Study ERIDANO. Hypertens Res. 2023;46(6):1570-1581. PubMed PMID: 36805031.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO. AU - Vallelonga,Fabrizio, AU - Cesareo,Marco, AU - Menon,Leonardo, AU - Leone,Dario, AU - Lupia,Enrico, AU - Morello,Fulvio, AU - Totaro,Silvia, AU - Aggiusti,Carlo, AU - Salvetti,Massimo, AU - Ioverno,Antonella, AU - Maloberti,Alessandro, AU - Fucile,Ilaria, AU - Cipollini,Franco, AU - Nesti,Nicola, AU - Mancusi,Costantino, AU - Pende,Aldo, AU - Giannattasio,Cristina, AU - Muiesan,Maria Lorenza, AU - Milan,Alberto, Y1 - 2023/02/20/ PY - 2022/11/21/received PY - 2023/02/03/accepted PY - 2023/01/10/revised PY - 2023/6/6/medline PY - 2023/2/23/pubmed PY - 2023/2/22/entrez KW - emergency department KW - hypertension mediated organ damage KW - hypertensive emergencies KW - hypertensive urgencies KW - short-term blood pressure control SP - 1570 EP - 1581 JF - Hypertension research : official journal of the Japanese Society of Hypertension JO - Hypertens Res VL - 46 IS - 6 N2 - 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. SN - 1348-4214 UR - https://www.unboundmedicine.com/medline/citation/36805031/Hypertensive_emergencies_and_urgencies:_a_preliminary_report_of_the_ongoing_Italian_multicentric_study_ERIDANO_ DB - PRIME DP - Unbound Medicine ER -