Buso Giacomo, Weber Thomas, Fragoulis Christos, Grassi Guido, Agabiti-Rosei Claudia, Delles Christian, Doumas Michalis, Salvetti Massimo, Kreutz Reinhold, Tsioufis Konstantinos, Muiesan Maria Lorenza
Centro 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, Italy.
University of Lausanne, Lausanne, Switzerland.
Blood Press. 2025 Dec;34(1):2535689. doi: 10.1080/08037051.2025.2535689. Epub 2025 Jul 24.
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.
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.
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 proposed definition involving at least three target organ damages in patients with BP >200/120 mmHg.
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.
急性血压升高在急诊环境中很常见，传统上分为高血压急症（HU）和高血压危象（HE）。恶性高血压（MHT）是HE的一种严重形式，其特征是小血管损伤。尽管国际指南提供了明确的定义和治疗策略，但实际数据显示，这些患者的诊断和管理仍然存在持续的分歧和异质性。
由欧洲高血压学会（ESH）发起的一项基于网络的匿名调查在来自18个欧洲国家和4个非欧洲国家的医生中进行。问卷评估了HU、HE和MHT的定义、诊断检查、血压测量方法以及治疗策略。
56个中心的64名参与者完成了调查。45.3%的受访者正确地将HU定义为严重血压升高且无急性临床症状性高血压介导的器官损害（A-HMOD）。79.7%的受访者可以使用小号袖带，70.3%的受访者可以使用特大号袖带。88.7%的参与者对HE使用静脉降压治疗，而20.6%的人也对HU使用静脉药物。MHT的定义和治疗方法差异很大，62.9%的人采用了提议的定义，即血压>200/120 mmHg的患者至少有三种靶器官损害。
这项国际调查突出了急性血压升高在定义、诊断检查和治疗管理方面存在的显著差异，强调了统一方案和进一步教育的必要性。
