OBJECTIVE:Hypertensive urgencies (HU) and hypertensive emergencies (HE) have significant clinical and public health implications, yet standardized management strategies are lacking. To address this gap, the European Society of Hypertension (ESH) initiated the ESH-URGEM registry to assess the epidemiology, clinical characteristics, and management of HU and HE across Europe over 12 months. METHODS:ESH conducted a prospective, observational study in emergency departments (EDs) of ESH-affiliated hospitals (ESH Excellence Centers). Adult patients (≥18 years) presenting with HU or HE were enrolled during ≥12-h shifts, once weekly, over 1 year. RESULTS:Among 115 169 ED visits, 998 cases (0.87%) were identified as hypertensive crises (HC): 77.3% HU and 22.7% HE. HE patients were older (mean age 70 vs. 66 years; P  = 0.004) and had more comorbidities, including coronary artery disease, heart failure, and chronic kidney disease. The most frequent triggers were emotional stress (44.8%), acute pain (33.7%), and medication nonadherence (15.5%). HE commonly manifested as acute coronary syndromes (39.6%), pulmonary edema (33.8%), or neurological complications (14.1%). HE treatment most often included intravenous nitrates (60.5%) and diuretics (45.8%). Also, 35.1% of HU cases also received intravenous therapy. Only 18.9% of HE patients were admitted to coronary or intensive care units, while 16.1% of HU patients were hospitalized, frequently for nonhypertension-related conditions. Guideline-recommended assessments for target organ damage and cardiovascular risk estimation such as fundoscopy and albuminuria testing were rarely performed. CONCLUSIONS:This registry highlights critical issues in the ED management of HC and hypertension, including: underdiagnosis of chronic hypertension, insufficient admission of HE patients to intensive or coronary care units, overly aggressive treatment of HU, and underuse of fundoscopy and albuminuria screening. Addressing these deficiencies through guideline implementation, structured care pathways, and improved follow-up could enhance outcomes for this high-risk population.

The problem of heart failure (HF) is complicated and is continuously growing, making the need for novel solutions critical. The role of melatonin, widely used as an over-the-counter medication for sleep disorders, has been historically researched for its cardioprotective actions based on its established antioxidant properties. Recent preliminary evidence, however, points to a possibly alarming association: A statistically significant increased risk of new onset HF, HF requiring hospitalization, and all-cause mortality was observed in association with long-term melatonin therapy (one year or longer in duration), in adult patients suffering from insomnia. However, these were reported in a single, as-yet unpublished conference abstract that has not undergone peer review or independent validation. This hypothesis-generating observation warrants careful investigation of possible mechanisms. In this article we speculatively propose a plausible - but as yet unconfirmed - mechanistic pathway mediated through prolactin (PRL). Melatonin may increase the release of PRL through its modulation of hypothalamic dopaminergic neurons, though whether this effect is sustained with long-term use remains an unresolved critical knowledge gap. This is particularly relevant given that peripartum cardiomyopathy, a dangerous, pregnancy-related variant of HF, has as its central mechanism the cardiotoxic effect of a cytotoxic 16-kDa fragment of PRL. We hypothesize that chronic exogenous melatonin use might - if it were shown to sustain hyperprolactinemia - provide excess PRL that could theoretically be cleaved to the cardiotoxic 16-kDa fragment in patients with pre-existing oxidative stress and cardiovascular risk factors, in a manner analogous to peripartum cardiomyopathy. This speculative mechanism should be tested in prospective mechanistic and clinical studies, with appropriate adjustment for confounders including insomnia severity.

BACKGROUND:Resistant hypertension remains a major clinical challenge. This systematic review/meta-analysis evaluated whether the addition of a single pharmacological or device-based intervention (renal denervation [RDN]) can achieve effective blood pressure (BP) control in patients with true resistant hypertension. METHODS:A systematic search of MEDLINE/PubMed was performed to identify studies assessing the antihypertensive effects of adding a single pharmacological or device-based intervention in patients with true resistant hypertension. Primary analyses were conducted using a single-arm framework. RESULTS:Sixty-eight studies were included (n=6297; weighted mean age, 60 years; men 60%; diabetes 35%; smoking 16%; cardiovascular disease 27%). Participants received an average of 4.8 antihypertensive medications, with baseline office BP of 164/92 mm Hg and 24-hour ambulatory BP of 148/85 mm Hg. The median follow-up was 6 months. Meta-analysis of 58 studies (n=4579; 52% RDN) demonstrated a pooled mean 24-hour systolic ambulatory BP reduction from baseline of -11.3 mm Hg (95% CI, -12.3 to -10.2). Meta-analysis of 15 studies (n=2700; 15% RDN) showed a pooled hypertension control rate during follow-up of 35% (95% CI, 28-42). No significant differences were observed between RDN and pharmacotherapy or between randomized and nonrandomized studies. CONCLUSIONS:A single intervention-either pharmacological or RDN-on top of guideline-directed background therapy resulted in clinically meaningful BP reduction in patients with true resistant hypertension; however, only one-third of patients achieved BP control. Future clinical trials are needed to evaluate whether combination treatment strategies integrating optimized pharmacological regimens with RDN can provide more effective and durable BP control in this particularly challenging patient population.

Growing evidence on the long-term efficacy and safety of sympathetic renal denervation (RDN) has established this neuromodulatory interventional therapy as the third therapeutic pillar for hypertension management, alongside lifestyle modification and pharmacotherapy. Accordingly, recent European and American guidelines have upgraded the role of RDN, recommending its consideration as an additional treatment option for selected patients with resistant or uncontrolled hypertension-particularly, for those at high cardiovascular risk-when performed in experienced centers with appropriate training and within a shared decision-making framework that respects patients' preferences. This consensus document, jointly developed by the Hellenic Society of Hypertension (Hellenic Excellence Centers of Hypertension), the Hellenic Society of Cardiology (Working Groups "Hypertension and Heart" and "Interventional Cardiology"), the Hellenic Society of Nephrology, and the Hellenic Academy of General Practice/Family Medicine and Primary Health Care, aims to provide a structured referral pathway for the clinical use of RDN in Greece. The proposed pathway integrates all contemporary therapeutic options in alignment with current hypertension guidelines and takes into account the structure of the Greek health care system. Ongoing and future research regarding antihypertensive therapies, including novel device-based and pharmacological interventions, is anticipated to further refine patient selection, procedural techniques, and long-term strategies to optimize cardiometabolic outcomes.

Abstract The May Measurement Month (MMM) 2023 global blood pressure (BP) screening campaign was conducted in Greece aiming to raise hypertension awareness and control in the general population. Volunteers aged ≥18 years were recruited through opportunistic screening in 11 cities. Each participant was assessed with triplicate seated BP measurements using validated automated upper-arm cuff devices and a standardized questionnaire on medical history. These data were submitted online through a custom-designed app of the global MMM campaign. Hypertension was defined as BP ≥140/90mmHg (average of second-third measurement) and/or use of antihypertensive drugs. A total of 5,437 individuals were analysed (mean age 53±17.1 years, 46.2% men, 27.8% current smokers, 10.9% with diabetes, 6.7% with cardiovascular disease) and 41.7% were hypertensive. The prevalence of hypertension was higher in men compared to women and in older compared to youngers individuals. Among hypertensives, 73.9% were unaware of their diagnosis, 69.9% were on antihypertensive drugs, and 47.6% were treated and controlled (BP <140/90mmHg). These data suggest that in Greece a high prevalence of hypertension persists, and often is undiagnosed, untreated, and uncontrolled. Global BP screening campaigns such as MMM are important and need to be complemented by public health initiatives at a national level for improving hypertension diagnosis and control.

The occurrence of cardiotoxicity compromises the prognosis of the oncological patients and blunts the optimal outcome of the antineoplastic treatment. Therefore, when occurring, it is a challenge to evaluate predictive risk stratification markers for morbidity, mortality and cardiotoxicity recovery. To assess the inotropic reserve of the Left Ventricle for improving the prognosis of patients with established cardiotoxicity. Women with breast cancer and documented chemotherapy-induced cardiotoxicity according to ESC guidelines (LVEF 38±12%) were studied. All patients were treated with the guidelines -based heart failure treatment. Follow-up of patients recording cardiovascular mortality and hospitalizations was performed for two years. One hundred and three patients (age 50±14 years) with cardiovascular events demonstrated a blunted response to dobutamine administration (ΔCO 29±22% vs 46±31%, p < 0.0001). A ΔCO <25% was considered as the cut-off for the inotropic reserve threshold .The cut-off of ΔWMSI for cardiovascular events was considered to be 0.35 with a specificity of 86% and sensitivity of 72% . In multivariate analysis, inotropic reserve HR 7.22 (95% CI 2.3-17.6; p=0.001) and NYHA functional stage HR 8.4 (95% CI 2.7-24.3; p=0.001) were independent predictors of cardiovascular death. At 1.1±0.8 years LVEF improved in 58 % of patients demonstrating the presence of inotropic reserve with ΔWMSI 0.62 predicting resuscitated EF with a specificity of 77% and sensitivity of 73%. Finally, 3 cardiovascular deaths and 22 hospitalizations for heart failure were recorded after 1.4±1.2 years. The presence of inotropic reserve contributes to the estimation of the burden of oncological-therapy induced cardiotoxicity and predicts reversibility of cardiac dysfunction in cardio-oncology patients.

OBJECTIVE:Hypertension is related to the pathogenesis of microvascular dysfunction. Renal denervation is a guideline-endorsed intervention for the management of uncontrolled hypertension. However, the effect of renal denervation on skin capillary density, as assessed by nailfold capillaroscopy, is unknown. METHODS:Individuals with stage I/II uncontrolled hypertensions were enrolled and allocated to either undergo renal denervation or serve as controls. Nailfold capillaroscopy was performed at baseline and at 12 months. Furthermore, the albumin to creatinine ratio (ACR) and office/ambulatory blood pressure (BP) levels were monitored throughout the study. RESULTS:A total of 45 individuals (28 renal denervation, 17 control) were enrolled in our study. No difference was found in baseline capillary density. At 12 months, all patients had controlled BP, while the denervation arm had a significantly greater number of capillaries, compared with control (90.9 ± 14.0 vs. 82.5 ± 10.6 capillaries/mm2; p = 0.036). However, the change from baseline capillary density was not significantly different between groups (4.6 ± 6.1 vs. 1.39 ± 8.8 capillaries/mm2; p = 0.150). Moreover, the change of ACR was not different between groups (-2.7 ± 13.8 vs. 0.46 ± 5.2; p = 0.365). CONCLUSION:In patients with uncontrolled stage I/II hypertension, renal denervation may have a beneficial effect on skin capillary density.