Highlights
- •State of art of management and treatment of hypertension emergency/urgency in Italy.
- •Good knowledge of definition and treatment.
- •Fair quality of blood pressure measurement technique.
- •Lack of protocol or fast track for this problem.
- •Differences in terms of treatment and diagnosis across macro-areas.
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.
Keywords
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Article info
Publication history
Published online: November 02, 2019
Accepted:
October 5,
2019
Received in revised form:
August 26,
2019
Received:
July 4,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
