Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension
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 internation...
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Taylor & Francis Group
2025-12-01
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| Series: | Blood Pressure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/08037051.2025.2535689 |
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| author | Giacomo Buso Thomas Weber Christos Fragoulis Guido Grassi Claudia Agabiti-Rosei Christian Delles Michalis Doumas Massimo Salvetti Reinhold Kreutz Konstantinos Tsioufis Maria Lorenza Muiesan |
| author_facet | Giacomo Buso Thomas Weber Christos Fragoulis Guido Grassi Claudia Agabiti-Rosei Christian Delles Michalis Doumas Massimo Salvetti Reinhold Kreutz Konstantinos Tsioufis Maria Lorenza Muiesan |
| author_sort | Giacomo Buso |
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| description | 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. |
| format | Article |
| id | doaj-art-002780d2756b4ded8a185bb77ae80c99 |
| institution | Kabale University |
| issn | 0803-7051 1651-1999 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
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| series | Blood Pressure |
| spelling | doaj-art-002780d2756b4ded8a185bb77ae80c992025-08-20T03:31:46ZengTaylor & Francis GroupBlood Pressure0803-70511651-19992025-12-0134110.1080/08037051.2025.2535689Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertensionGiacomo Buso0Thomas Weber1Christos Fragoulis2Guido Grassi3Claudia Agabiti-Rosei4Christian Delles5Michalis Doumas6Massimo Salvetti7Reinhold Kreutz8Konstantinos Tsioufis9Maria Lorenza Muiesan10Centro per la Prevenzione e Cura dell’ipertensione Arteriosa, Department of Clinical and Experimental Sciences, University of Brescia and Division of Internal Medicine ASST Spedali Civili, Brescia, ItalyCardiology Department, Klinikum Wels-Grieskirchen, Wels, AustriaFirst Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, GreeceDepartment of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Milan, ItalyCentro per la Prevenzione e Cura dell’ipertensione Arteriosa, Department of Clinical and Experimental Sciences, University of Brescia and Division of Internal Medicine ASST Spedali Civili, Brescia, ItalySchool of Cardiovascular and Metabolic Health, University of Glasgow and Queen Elizabeth University Hospital, Glasgow, UKSecond Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GreeceCentro per la Prevenzione e Cura dell’ipertensione Arteriosa, Department of Clinical and Experimental Sciences, University of Brescia and Division of Emergency Medicine ASST Spedali Civili, Brescia, ItalyCharité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, Berlin, GermanyFirst Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, GreeceCentro per la Prevenzione e Cura dell’ipertensione Arteriosa, Department of Clinical and Experimental Sciences, University of Brescia and Division of Internal Medicine ASST Spedali Civili, Brescia, ItalyBackground 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.https://www.tandfonline.com/doi/10.1080/08037051.2025.2535689Hypertensive emergencieshypertensive urgenciesmalignant hypertensionreal-world managementtreatment |
| spellingShingle | Giacomo Buso Thomas Weber Christos Fragoulis Guido Grassi Claudia Agabiti-Rosei Christian Delles Michalis Doumas Massimo Salvetti Reinhold Kreutz Konstantinos Tsioufis Maria Lorenza Muiesan Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension Blood Pressure Hypertensive emergencies hypertensive urgencies malignant hypertension real-world management treatment |
| title | Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension |
| title_full | Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension |
| title_fullStr | Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension |
| title_full_unstemmed | Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension |
| title_short | Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension |
| title_sort | diagnostic and therapeutic approach to acute blood pressure elevations results of an international survey among excellence centres of the european society of hypertension |
| topic | Hypertensive emergencies hypertensive urgencies malignant hypertension real-world management treatment |
| url | https://www.tandfonline.com/doi/10.1080/08037051.2025.2535689 |
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