EARLY RESULTS OF THE PROSPECTIVE MULTIDISCIPLINARY HAMA COHORT: DESCRIPTION OF THE FIRST 302 PATIENTS, COMPARISON WITH ALREADY PUBLISHED COHORT AND NOVEL INSIGHTS

Abstract

Listen

Translate article

Objective: Malignant hypertension has not disappeared and remains the most severe form of hypertension. More than 100 years after its description, many points remain unanswered. Mechanisms, definition and optimal treatment are still discussed. In 2019 we decided to launch a prospective multicenter multidisciplinary cohort in France try filling these gaps. Thjs study aims to describe the baseline characteristics of the first 302 included patients and compare these data to already published cohorts. Design and method: We included patient with severe hypertension and severe hypertensive retinopathy and patients filling the HYP MOD definition from a broad range of department (cardiology, nephrology, neurology intensive care unit, emergency department, internal medicine). We collected clinical data at admission, biological, imaging and target organ damage along with social and demographic data. We also recorded diagnostic and therapeutic management, adverse events during hospitalization and characteristics at discharge. Results: We recruited 302 patients in 32 month (105 / year) among 40 centres and different specialities. They are mostly young men (68%, mean age 48.7 +/- 14.5 years), with several interesting subgroups. Around one third of our patients were less than 40 years old, one third were from non-European origin, 13.6% were included through the multiorgan damage definition, without fundus severe injuries. Target organ damage involves the eye in 86% of patients, kidney in 54%, heart in 56%, brain in 33% and Thrombotic Microangiopathy in 13%. Our patients with severe retinopathy are very similar with those included in the most important cohorts already published. Interestingly, 22.8% of patients were treated without use of IV therapy, most patients were untreated or showed poor observance of treatments and a significant proportion had normal or low renin level. Conclusions: These preliminary findings already challenge long standing dogma, raise many questions and provide a strong basis to address them in ancillary studies of the cohort.