Cardiovascular Hypertension-Mediated Organ Damage in Hypertensive Urgencies and Hypertensive Outpatients

Vallelonga, Fabrizio; Cesareo, Marco; Menon, Leonardo; Airale, Lorenzo; Leone, Dario; Astarita, Anna; Mingrone, Giulia; Tizzani, Maria; Lupia, Enrico; Veglio, Franco; Milan, Alberto

doi:10.3389/fcvm.2022.889554

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…At 72 h visit, patients with uncontrolled BP had worse PWV, suggesting a possible role of aortic stiffness in impeding proper BP control, or possibly grater vascular damage in patients with short-term uncontrolled BP. A recent study showed that HU patients had subclinical HMOD profile midway between patients with asymptomatic grade 3 hypertension and patients with various grade hypertension, matched for office BP [ 50 ]. The higher prevalence of subclinical HMOD in HE patients found in the present study underlines that HE patients have worse baseline CV risk profile than HU patients, leading to more severe manifestations of acute BP rise.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…An increased interventricular septum thickness can indicate hypertension‐mediated target‐organ damage in the heart, and is a commonly reported outcome in clinical practice. 50 , 51 The European Society of Cardiology/European Society of Hypertension recommends the assessment of interventricular septum thickness in patients with hypertension, as a reduction in blood pressure levels leads to a regression of interventricular septum thickness and LV hypertrophy, with a consecutive decrease in cardiovascular disease risk. 52 In the current analysis, the extensive reduction in systolic blood pressure could help explain the significant decrease in interventricular septum thickness; however, the decrease in interventricular septum thickness appears to be independent of blood pressure or antihypertensive medication (Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

The Contribution of Declines in Blood Lead Levels to Reductions in Blood Pressure Levels: Longitudinal Evidence in the Strong Heart Family Study

Lieberman‐Cribbin,

Li,

Lewin

et al. 2024

JAHA

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Background Chronic lead exposure is associated with both subclinical and clinical cardiovascular disease. We evaluated whether declines in blood lead were associated with changes in systolic and diastolic blood pressure in adult American Indian participants from the SHFS (Strong Heart Family Study). Methods and Results Lead in whole blood was measured in 285 SHFS participants in 1997 to 1999 and 2006 to 2009. Blood pressure and measures of cardiac geometry and function were obtained in 2001 to 2003 and 2006 to 2009. We used generalized estimating equations to evaluate the association of declines in blood lead with changes in blood pressure; cardiac function and geometry measures were considered secondary. Mean blood lead was 2.04 μg/dL at baseline. After ≈10 years, mean decline in blood lead was 0.67 μg/dL. In fully adjusted models, the mean difference in systolic blood pressure comparing the highest to lowest tertile of decline (>0.91 versus <0.27 μg/dL) in blood lead was −7.08 mm Hg (95% CI, −13.16 to −1.00). A significant nonlinear association between declines in blood lead and declines in systolic blood pressure was detected, with significant linear associations where blood lead decline was 0.1 μg/dL or higher. Declines in blood lead were nonsignificantly associated with declines in diastolic blood pressure and significantly associated with declines in interventricular septum thickness. Conclusions Declines in blood lead levels in American Indian adults, even when small (0.1–1.0 μg/dL), were associated with reductions in systolic blood pressure. These findings suggest the need to further study the cardiovascular impacts of reducing lead exposures and the importance of lead exposure prevention.

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“…Hypertension urgencies were defined as acute elevation of blood pressure (usually systolic blood pressure (SBP)>180mmHg and/or diastolic blood pressure (DBP)>110mmHg) without impairment of target organ function. 10 Exclusion criteria included patients with primary renal insufficiency, valvular heart disease, and metabolic diseases. Patients with allergies to the drugs administered in this study were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Effect of Sleep Duration on Blood Pressure in Patients with SARS-CoV-2 Infection and Hypertensive Urgencies in Shanghai Fangcang Shelter Hospital

Shi¹,

Ding²,

Hu³

et al. 2023

IDR

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Objective To evaluate the effect of sleep duration on blood pressure in patients with hypertension urgencies combined with SARS-CoV-2 infection in a Fangcang shelter hospital. Methods From April 10, 2020 to May 20, 2022, we statistically analyzed the blood pressure and sleep conditions of 52 patients with combined hypertension urgencies and SARS-CoV-2 infection admitted in Shanghai National Convention and Exhibition Center Fangcang shelter hospital. They were divided into the short-term (daily sleep duration: <7 h) and normal sleep group (7–9 h). We performed a comparison of the control effects of basic antihypertensive drugs. Additionally, patients in the short-term sleep group underwent drug therapy for sleep regulation and continuous monitoring of blood pressure. Results Among these patients, the blood pressure was higher in the short-term sleep group than that of the normal sleep group, and also more difficult to control ( p <0.05). Furthermore, the blood pressure of the patients in the short-term sleep group was more easily controlled after treatment with drugs for sleep regulation and basic antihypertensive drugs ( p <0.05). Conclusion The blood pressure level in patients with combined SARS-CoV-2 infection and hypertension urgencies was higher in those with a shorter duration of daily sleep, and also more difficult to control in Fangcang shelter hospital. Drug therapy for sleep regulation should be administered early to obtain sufficient blood pressure control effects.

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Cardiovascular Hypertension-Mediated Organ Damage in Hypertensive Urgencies and Hypertensive Outpatients

Cited by 4 publications

References 28 publications

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

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

The Contribution of Declines in Blood Lead Levels to Reductions in Blood Pressure Levels: Longitudinal Evidence in the Strong Heart Family Study

Effect of Sleep Duration on Blood Pressure in Patients with SARS-CoV-2 Infection and Hypertensive Urgencies in Shanghai Fangcang Shelter Hospital

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