Blood pressure · 2025
Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Buso Giacomo, Weber Thomas, Fragoulis Christos, Grassi Guido, Agabiti-Rosei Claudia, Delles Christian, Doumas Michalis, Salvetti Massimo, Kreutz Reinhold, Tsioufis Konstantinos, Muiesan Maria Lorenza
Аннотация
BACKGROUND: Acute blood pressure (BP) elevations are common in emergency settings and are traditionally classified into hypertensive urgencies (HU) and hypertensive emergencies (HE). Malignant hypertension (MHT) represents a severe form of HE characterised by small vessel damage. Although international guidelines provide clear definitions and treatment strategies, real-world data have shown persistent fragmentation and heterogeneity in the diagnosis and management of these patients.
METHODS: A web-based, anonymous survey promoted by the European Society of Hypertension (ESH) was distributed among physicians from 18 European and 4 non-European countries. The questionnaire assessed definitions, diagnostic work-up, BP measurement practices, and therapeutic strategies for HU, HE, and MHT.
RESULTS: Sixty-four participants in 56 centres completed the survey. HU was correctly defined as a severe BP elevation without acute clinically symptomatic hypertension-mediated organ damage (A-HMOD) by 45.3% of respondents. Small cuffs were available to 79.7% and extra-large cuffs to 70.3% of respondents.. Intravenous antihypertensive therapy was used for HE by 88.7% of participants, while 20.6% also used intravenous drugs for HU. Parenteral clonidine and sublingual nifedipine were prescribed by 29.7% and 26.6% of respondents, respectively. Definitions and therapeutic approaches for MHT varied substantially, with 62.9% adopting a recently proposed definition involving at least three target organ damages in patients with BP >200/120 mmHg.
CONCLUSIONS: This international survey highlights considerable variability in the definition, diagnostic work-up, and therapeutic management of acute BP elevations, emphasising the need for harmonised protocols and further education.
METHODS: A web-based, anonymous survey promoted by the European Society of Hypertension (ESH) was distributed among physicians from 18 European and 4 non-European countries. The questionnaire assessed definitions, diagnostic work-up, BP measurement practices, and therapeutic strategies for HU, HE, and MHT.
RESULTS: Sixty-four participants in 56 centres completed the survey. HU was correctly defined as a severe BP elevation without acute clinically symptomatic hypertension-mediated organ damage (A-HMOD) by 45.3% of respondents. Small cuffs were available to 79.7% and extra-large cuffs to 70.3% of respondents.. Intravenous antihypertensive therapy was used for HE by 88.7% of participants, while 20.6% also used intravenous drugs for HU. Parenteral clonidine and sublingual nifedipine were prescribed by 29.7% and 26.6% of respondents, respectively. Definitions and therapeutic approaches for MHT varied substantially, with 62.9% adopting a recently proposed definition involving at least three target organ damages in patients with BP >200/120 mmHg.
CONCLUSIONS: This international survey highlights considerable variability in the definition, diagnostic work-up, and therapeutic management of acute BP elevations, emphasising the need for harmonised protocols and further education.