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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).
Eur J Intern Med. 2020 01; 71:50-56.EJ

Abstract

Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Saladini F
Department of Medicine, University of Padova, Italy; Cardiology Unit, Cittadella Town Hospital, Padova, Italy. Electronic address: saladinifrancesca@gmail.com.
Mancusi C
Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University of Naples, Italy.
Bertacchini F
Internal Medicine, University of Brescia-ASST Spedali Civili di Brescia, Italy.
Spannella F
Internal Medicine and Geriatrics, IRCCS-INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
Maloberti A
Cardiology 4, ASST Niguarda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
Giavarini A
Cardiology Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milano, Italy.
Rosticci M
Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, Italy.
Bruno RM
Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Pucci G
Internal Medicine, Department of Medicine, University of Perugia, Terni University Hospital, Italy.
Grassi D
Department of Internal medicine and Public Health, University of Aquila, Italy.
Pengo M
Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milano, Italy.
Muiesan ML
Internal Medicine, University of Brescia-ASST Spedali Civili di Brescia, Italy.

MeSH

Antihypertensive AgentsBlood Pressure Monitoring, AmbulatoryCritical CareEmergenciesEmergency Service, HospitalHumansHypertensionItaly

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31690479

Citation

Saladini, F, 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)." European Journal of Internal Medicine, vol. 71, 2020, pp. 50-56.
Saladini F, Mancusi C, Bertacchini F, 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). Eur J Intern Med. 2020;71:50-56.
Saladini, F., Mancusi, C., Bertacchini, F., Spannella, F., Maloberti, A., Giavarini, A., Rosticci, M., Bruno, R. M., Pucci, G., Grassi, D., Pengo, M., & Muiesan, M. L. (2020). 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). European Journal of Internal Medicine, 71, 50-56. https://doi.org/10.1016/j.ejim.2019.10.004
Saladini F, 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). Eur J Intern Med. 2020;71:50-56. PubMed PMID: 31690479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Saladini,F, AU - Mancusi,C, AU - Bertacchini,F, AU - Spannella,F, AU - Maloberti,A, AU - Giavarini,A, AU - Rosticci,M, AU - Bruno,R M, AU - Pucci,G, AU - Grassi,D, AU - Pengo,M, AU - Muiesan,M L, Y1 - 2019/11/02/ PY - 2019/07/04/received PY - 2019/08/26/revised PY - 2019/10/05/accepted PY - 2019/11/7/pubmed PY - 2021/2/16/medline PY - 2019/11/7/entrez KW - Hypertension emergency KW - Hypertension urgency KW - Management KW - Survey KW - Treatment SP - 50 EP - 56 JF - European journal of internal medicine JO - Eur J Intern Med VL - 71 N2 - Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy. SN - 1879-0828 UR - https://www.unboundmedicine.com/medline/citation/31690479/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__ DB - PRIME DP - Unbound Medicine ER -