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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.
J Clin Med. 2022 May 25; 11(11)JC

Abstract

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.

Authors+Show Affiliations

Department of Medicine, University of Padova, 35128 Padova, Italy. Cardiology Unit, Cittadella Town Hospital, Via Casa di Ricovero 40, 35013 Cittadella, Italy.Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University of Naples, 80131 Naples, Italy.Internal Medicine, University of Brescia-ASST Spedali Civili di Brescia, 25121 Brescia, Italy.Internal Medicine and Geriatrics, IRCCS-INRCA, 60127 Ancona, Italy. Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", 60126 Ancona, Italy.Cardiology 4, ASST Niguarda Hospital, 20121 Milan, Italy. School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy.Cardiology Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy.Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy.Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.Internal Medicine, Department of Medicine, University of Perugia, Terni University Hospital, 06132 Perugia, Italy.Department of Internal Medicine and Public Health, University of Aquila, 67100 L'Aquila, Italy.Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy.Internal Medicine, University of Brescia-ASST Spedali Civili di Brescia, 25121 Brescia, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35683380

Citation

Saladini, Francesca, et al. "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." Journal of Clinical Medicine, vol. 11, no. 11, 2022.
Saladini F, Mancusi C, Bertacchini F, et al. 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. J Clin Med. 2022;11(11).
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. (2022). 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. Journal of Clinical Medicine, 11(11). https://doi.org/10.3390/jcm11112986
Saladini F, et al. 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. J Clin Med. 2022 May 25;11(11) PubMed PMID: 35683380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Saladini,Francesca, AU - Mancusi,Costantino, AU - Bertacchini,Fabio, AU - Spannella,Francesco, AU - Maloberti,Alessandro, AU - Giavarini,Alessandra, AU - Rosticci,Martina, AU - Bruno,Rosa Maria, AU - Pucci,Giacomo, AU - Grassi,Davide, AU - Pengo,Martino, AU - Muiesan,Maria Lorenza, Y1 - 2022/05/25/ PY - 2022/04/25/received PY - 2022/05/23/revised PY - 2022/05/23/accepted PY - 2022/6/10/entrez PY - 2022/6/11/pubmed PY - 2022/6/11/medline KW - blood pressure KW - hypertensive emergency KW - hypertensive urgency KW - treatment JF - Journal of clinical medicine JO - J Clin Med VL - 11 IS - 11 N2 - 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. SN - 2077-0383 UR - https://www.unboundmedicine.com/medline/citation/35683380/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. DB - PRIME DP - Unbound Medicine ER -