SUBCLINICAL HYPERTENSION-MEDIATED ORGAN DAMAGE AND PROGNOSIS IN PATIENTS WITH HYPERTENSIVE EMERGENCIES AND URGENCIES: REPORT FROM THE ONGOING MULTICENTER ERIDANO STUDY

Objective: Acute hypertensive disorders (namely hypertensive urgencies [HU] and hypertensive emergencies [HE]) are challenges for the Emergency Department (ED) and hypertension experts. The ongoing prospective multicenter study Eridano aims to characterize patients with HE and HU, prevalence of subclinical hypertension-mediated organ damage (HMOD), and short- and long-term prognosis. Design and method: Patients admitted to the ED with symptomatic blood pressure (BP) > or = 180/110 mmHg were enrolled. They were managed by ED personnel according to their clinical presentations. They subsequently underwent clinical evaluation and subclinical HMOD assessment at a Hypertension Center within 72h from enrolment, and then clinical follow-up at 3 and 12 months. The endpoints considered were new HU and HE, acute coronary syndrome (ACS), acute aortic syndrome (AAS), stroke, and heart failure hospitalization. Results: 258 patients were enrolled until October 2023. Mean age was 60±15 years, 130 (50%) were females. 28 (11%) and 230 (89%) patients were diagnosed with HE and HU, respectively. Mean systolic and diastolic BP at ED admission were 189±24 and 105±18 mmHg, respectively. BP values <180/110 mmHg were achieved in 57% and 91% of HE and HU patients, respectively. Mean systolic and diastolic BP at 72h visit were 148±22 and 87±15 mmHg, respectively, and 35% of patients were normotensive. The overall prevalence of subclinical HMOD in at least one site was 74%. The most frequent was cardiac HMOD (41%), followed by vascular (36%), cerebral (25%), and renal (13%) ones. HE patients had higher prevalence of cardiac, cerebral, and renal HMOD than HU patients (p<0.01 for all), while vascular HMOD was similar. 194 patients underwent 3 months follow-up and 113 patients completed 12 months follow-up. A total of 30 events occurred (12%), namely 21 HU, 4 ACS, 2 stroke, 1 HE, and 2 deaths. Five HE patients (18%) and 25 HU patients (11%) experienced at least one events. Conclusions: Subclinical hypertension-mediated organ damage is highly prevalent in patients with acute blood pressure disorders. The heart is the most frequent location involved in subclinical HMOD. Hypertensive emergencies and urgencies carry high risk of recurrent BP disorder and cardiovascular complications.