Differences in Diagnosis and Management of Hypertensive Urgencies and Emergencies According to Italian Doctors from Different Departments Who Deal With Acute Increase in Blood Pressure—Data from Gear (Gestione Dell’emergenza e Urgenza in ARea Critica) Study

Background: Diagnosis and treatment of hypertension emergency (HE) and urgency (HU) may vary according to the physicians involved and the setting of the treatment. The aim of this study was to investigate differences in management of HE and HU according to the work setting of the physicians. Methods: The young investigators of the Italian Society of Hypertension developed a 23-item questionnaire spread by email invitation to the members of Italian Scientific societies involved in the field of emergency medicine and hypertension. Results: Six-hundred and sixty-five questionnaires were collected. No differences emerged for the correct definitions of HE and HU or for the investigation of possible drugs that may be responsible for an acute increase in BP. The techniques used to assess BP values (p < 0.004) and the sizes of cuffs available were different according to the setting. Cardiologists more frequently defined epistaxis (55.2% p = 0.012) and conjunctival hemorrhages (70.7%, p < 0.0001) as possible presentation of HE, and rarely considered dyspnea (67.2% p = 0.014) or chest pain (72.4%, p = 0.001). Intensive care (IC) unit doctors were more familiar with lung ultrasound (50% p = 0.004). With regard to therapy, cardiologists reported the lowest prescription of i.v. labetalol (39.6%, p = 0.003) and the highest of s.l. nifedipine (43.1% p < 0.001). After discharge, almost all categories of physicians required home BP assessment or referral to a general practitioner, whereas hypertensive center evaluation or ambulatory BP monitoring were less frequently suggested. Conclusion: Management and treatment of HE and HU may be different according to the doctor’s specialty. Educational initiatives should be done to standardize treatment protocols and to improve medical knowledge.

[1]  Dorairaj Prabhakaran,et al.  2020 International Society of Hypertension Global Hypertension Practice Guidelines. , 2020, Hypertension.

[2]  Benjamin K. P. Woo,et al.  Hypertensive emergencies and urgencies: a single-centre experience in Northern Italy 2008-2015. , 2020, Journal of hypertension.

[3]  M. Muiesan,et al.  Hypertensive emergencies and urgencies: a single-centre experience in Northern Italy 2008-2015. , 2020, Journal of hypertension.

[4]  C. Mancusi,et al.  Point‐of‐care ultrasound with pocket‐size devices in emergency department , 2019, Echocardiography.

[5]  G. Lip,et al.  ESC Council on hypertension position document on the management of hypertensive emergencies. , 2018, European heart journal. Cardiovascular pharmacotherapy.

[6]  M. Muiesan,et al.  Diagnosis and treatment of hypertensive emergencies and urgencies among Italian emergency and intensive care departments. Results from an Italian survey: Progetto GEAR (Gestione dell'Emergenza e urgenza in ARea critica). , 2020, European journal of internal medicine.

[7]  G. Lip,et al.  2018 ESC/ESH Guidelines for the management of arterial hypertension. , 2018, European heart journal.

[8]  R. Brook,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Journal of the American Society of Hypertension : JASH.

[9]  M. Rothberg,et al.  Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. , 2016, JAMA internal medicine.

[10]  P. Pellikka,et al.  Ultrasound of extravascular lung water: a new standard for pulmonary congestion , 2016, European heart journal.

[11]  W. Young,et al.  The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. , 2016, The Journal of clinical endocrinology and metabolism.

[12]  M. Muiesan,et al.  An update on hypertensive emergencies and urgencies , 2015, Journal of cardiovascular medicine.

[13]  E. Sanidas,et al.  Cardiovascular Hypertensive Emergencies , 2015, Current Hypertension Reports.

[14]  G. Bruno,et al.  Hospital Admissions for Hypertensive Crisis in the Emergency Departments: A Large Multicenter Italian Study , 2014, PloS one.

[15]  Jeroen J. Bax,et al.  2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Blood pressure.

[16]  Michael Böhm,et al.  2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Journal of hypertension.

[17]  M. Stowasser,et al.  Factors Affecting the Aldosterone/Renin Ratio , 2011, Hormone and Metabolic Research.

[18]  Renan Oliveira Vaz-de-Melo,et al.  Hypertensive crisis: clinical–epidemiological profile , 2011, Hypertension Research.

[19]  J. Zamorano,et al.  The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. , 2011, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[20]  Ross Ward,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure , 2011 .

[21]  A. Amin,et al.  Practice patterns, outcomes, and end-organ dysfunction for patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension (STAT) registry. , 2009, American heart journal.

[22]  I. Wilkinson,et al.  The dangers of immediate-release nifedipine in the emergency treatment of hypertension , 2008, Journal of Human Hypertension.

[23]  V. Musini,et al.  Pharmacological interventions for hypertensive emergencies. , 2008, The Cochrane database of systematic reviews.

[24]  J. P. Cipullo,et al.  Hypertensive crisis profile. Prevalence and clinical presentation. , 2004, Arquivos brasileiros de cardiologia.

[25]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[26]  Baran.,et al.  Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial doppler ultrasonography during hypertensive crisis. , 2003, Blood pressure.

[27]  D. Deming,et al.  Evaluation of the safety of short-acting nifedipine in children with hypertension , 2002, Pediatric Nephrology.

[28]  Y. Liu,et al.  [The effect of Nifedipine on postpartum blood loss in patients with pregnancy induced hypertension]. , 2000, Zhonghua fu chan ke za zhi.

[29]  G. Vargas-Ayala,et al.  Comparison between isosorbide dinitrate aerosol and nifedipine in the treatment of hypertensive emergencies , 1999, Journal of Human Hypertension.

[30]  H. Yoshitomi,et al.  SUBLINGUAL NIFEDIPINE IN ELDERLY PATIENTS: EVEN A LOW DOSE INDUCES MYOCARDIAL ISCHAEMIA , 1999, Clinical and experimental pharmacology & physiology.

[31]  A. Coca,et al.  Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase. , 1999, Journal of cardiovascular pharmacology.

[32]  M. Fami,et al.  Another Report of Adverse Reactions to Immediate‐Release Nifedipine , 1998, Pharmacotherapy.

[33]  P. Kowey,et al.  Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? , 1996, JAMA.

[34]  M. Marchisio,et al.  Hypertensive urgencies and emergencies. Prevalence and clinical presentation. , 1996, Hypertension.