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<p>Elevated blood pressure (BP) ≥ 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines clearly define a diagnostic and management approach for hypertensive urgencies (HUs) and emergencies (HEs). The aim of this study was to report on physicians’ routine clinical practice regarding diagnosis and treatment of HUs and HEs. This observational cross-sectional study was conducted in tertiary hospitals of Thessaloniki, Greece. A specifically designed questionnaire was distributed to physicians working in the ED, who were actively implicated in the management of patients with HUs/HEs. Among 146 responders, only 54.1% correctly reported that HUs and HEs are characterized by an increase in BP ≥ 180/110 mmHg. Less than half (48.6%) stated that they routinely check for compliance with antihypertensive treatment. The vast majority routinely order an electrocardiogram (91.8%) and laboratory tests (79.5%) in patients attending the ED with BP ≥ 180/110 mmHg, but this percentage dropped to 61.0% for urinalysis. Only 21.2% routinely order a fundoscopic examination. Calcium channel blockers would be the first drug to administer by 63.0% of study participants to HUs, whereas only 40.4% would choose intravenous labetalol as the first-line antihypertensive medication for malignant hypertension. Subgroup analysis revealed significant differences according to the most prevalent ED specialties of Internal Medicine, General Practice and Cardiology. The diagnostic approach and therapeutic management of HUs or HEs may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines. More efforts are warranted to educate physicians on this important clinical issue.</p>

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Deviations in the diagnostic and management approach of hypertensive urgencies and emergencies in routine clinical practice as compared to the guidelines: a survey of physicians in tertiary hospitals

  • 期刊论文

  • 发表日期：

    2025年11月28日

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  • Panagiota Anyfanti,
  • Christina Antza,
  • Eleni Karlafti,
  • Eleni Chovarda,
  • Konstantinos Triantafyllou,
  • Georgios Styliadis,
  • Eugenia Gkaliagkousi,
  • Vasilios Kotsis

摘要

Elevated blood pressure (BP) ≥ 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines clearly define a diagnostic and management approach for hypertensive urgencies (HUs) and emergencies (HEs). The aim of this study was to report on physicians’ routine clinical practice regarding diagnosis and treatment of HUs and HEs. This observational cross-sectional study was conducted in tertiary hospitals of Thessaloniki, Greece. A specifically designed questionnaire was distributed to physicians working in the ED, who were actively implicated in the management of patients with HUs/HEs. Among 146 responders, only 54.1% correctly reported that HUs and HEs are characterized by an increase in BP ≥ 180/110 mmHg. Less than half (48.6%) stated that they routinely check for compliance with antihypertensive treatment. The vast majority routinely order an electrocardiogram (91.8%) and laboratory tests (79.5%) in patients attending the ED with BP ≥ 180/110 mmHg, but this percentage dropped to 61.0% for urinalysis. Only 21.2% routinely order a fundoscopic examination. Calcium channel blockers would be the first drug to administer by 63.0% of study participants to HUs, whereas only 40.4% would choose intravenous labetalol as the first-line antihypertensive medication for malignant hypertension. Subgroup analysis revealed significant differences according to the most prevalent ED specialties of Internal Medicine, General Practice and Cardiology. The diagnostic approach and therapeutic management of HUs or HEs may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines. More efforts are warranted to educate physicians on this important clinical issue.