{Reference Type}: Journal Article
{Title}: Persistently elevated sFlt-1 and recovery of reduced ADAMTS13 activity in malignant hypertension.
{Author}: Ma H;Wang C;Jiang M;Jin K;Xu T;Wang Z;Xu J;Ni L;Shi H;Shen P;Chen Y;Feng X;Zhang W;
{Journal}: J Hypertens
{Volume}: 42
{Issue}: 3
{Year}: 2024 Mar 1
{Factor}: 4.776
{DOI}: 10.1097/HJH.0000000000003601
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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  = 48) and non-MHT ( n  = 36) 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.<BR><B>RESULTS: </B>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 53 ± 13 months, the restoration of reduced ADAMTS13 activity was correlated with the improvement of kidney function and independently reduced the risk of renal endpoints.<BR><B>CONCLUSIONS: </B>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.