Long-term series of meteorological, hydrological and oceanographic data were compared with hypoxia occurrence, in order to define characteristics and trends of this phenomenon in the Emilia Romagna Coastal Zone (ERCZ) in 1977–2008. During this period, hypoxia was recorded at all sampling stations, up to 20 km offshore. In winter, spring and late autumn, hypoxia appearance was matched to significant positive anomalies of air and surface seawater temperatures (up to + 3.6 °C), whereas this effect was less pronounced in August–October. Hypoxia generally occurred with scarce precipitation (0–2 dm3 m2 d− 1) and low wind velocity (0–2 m s− 1), suggesting the importance of stable meteo-marine conditions for the onset of this phenomenon. Nevertheless, wind direction emerged as an indicator of hydrodynamic seasonal changes in the area and is thus a hypoxia regulator. In winter, spring and autumn, hypoxia was favored by large increases of biomass induced by river freshets. In contrast, summer hypoxia occurred during periods of low runoff, suggesting that pronounced stratification and weak circulation of coastal waters were more important in this season.Since the 1990s, a shift from widespread summer hypoxia to local hypoxia irregularly distributed across the year has occurred. This process was concomitant to long-term increases of air temperature (+ 0.14 °C yr− 1), wind speed (+ 0.03 m s− 1 yr− 1) and salinity (+ 0.09 yr− 1), and decreases of Po River flow (− 0.54 km3 yr− 1), oxygen saturation (− 0.2% yr− 1) and PO43 − (− 0.004 μmol P L− 1 yr− 1) and NH4+ (− 0.04 μmol N L− 1 yr− 1) concentrations in surface coastal waters. Despite that several of these changes suggest an ERCZ trophic level positive reduction, similar to that reported for the N Adriatic, the concomitant climate warming might further exacerbate hypoxia in particularly shallow shelf locations. Therefore, in order to avoid hypoxia development a further mitigation of anthropogenic pressure is still needed in the area.