Persistently elevated sFlt-1 and recovery of reduced ADAMTS13 activity in malignant hypertension.
J Hypertens
; 42(3): 410-419, 2024 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-37889602
ABSTRACT
BACKGROUND AND OBJECTIVES:
Malignant hypertension (MHT) characterized by acute hypertension with retinopathy or multiorgan damage, is a severe form of hypertensive emergency and associated with target organ involvement and poor kidney outcome. However, the underlying mechanisms are unclear.METHODS:
Eighty-four patients with acute severe hypertension from the Nephrology Department and Emergency Department in a single center during January 2016 and December 2017 were prospectively enrolled and divided into MHT ( n â=â48) and non-MHT ( n â=â36) subgroups according to target organ evaluation. Forty healthy controls were recruited. Serum soluble Fms-like tyrosine kinase-1 (sFlt-1) levels and plasma ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) activity were examined at baseline and 12-month follow-up. Renal endpoints were defined as a significant decrease in the estimated glomerular filtration rate (eGFR) of more than 40% or the occurrence of end-stage renal disease.RESULTS:
Serum sFlt-1 levels were persistently elevated in MHT. Baseline serum sFLT-1 levels were correlated with plasma ADAMTS13 activity and markers of target organ damage. Plasma ADAMTS13 activity was reduced in both MHT and non-MHT patients and recovered to the normal range at 12-month follow-up. During an average follow-up time of 53â±â13âmonths, the restoration of reduced ADAMTS13 activity was correlated with the improvement of kidney function and independently reduced the risk of renal endpoints.CONCLUSIONS:
Abnormal angiogenesis and endothelial damage are involved in the pathophysiology of hypertensive emergency. Evaluation of ADAMTS13 and sFlt-1 may help in the diagnosis and assessment of MHT. Recovery of ADAMTS13 predicts better renal outcome in patients with hypertensive emergencies.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Crise Hipertensiva
/
Hipertensão
/
Hipertensão Maligna
/
Falência Renal Crônica
Limite:
Humans
Idioma:
En
Revista:
J Hypertens
Ano de publicação:
2024
Tipo de documento:
Article