DIAGNOSTIC AND MANAGEMENT STEPS OF HYPERTENSIVE URGENCIES AND EMERGENCIES: A SURVEY OF PHYSICIANS’ PERCEPTIONS

Objective: Elevated blood pressure (BP) above 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines have clearly defined a diagnostic and therapeutic approach for hypertensive urgencies and emergencies. Nevertheless, both diagnostic approach and subsequent management steps may vary considerably in clinical practice. The aim of this study was to report on the knowledge and perceptions of physicians working in the ED of tertiary hospitals regarding the diagnostic and therapeutic approach of hypertensive urgencies or emergencies. Design and method: Physicians working in the ED of tertiary hospitals of Thessaloniki (Papageorgiou and Hippokration Hospital), Greece, either as full-time or during shifts, completed a specifically designed questionnaire. Results: A total of 73 physicians (50.7% men and 49.3% women), of whom 57.5% were residents and 42.5% attending physicians, completed the questionnaire. Of them, the majority were internists (58.9%), general practitioners (17.8%) and cardiologists (13.7%). Only 6 out of 10 (61.6%) correctly answered that hypertensive urgencies and emergencies are characterized by an increase in BP above 180/110 mmHg. Just approximately half of physicians (56.2%) stated that they almost always or always check patients attending the ED with BP above 180/110 mmHg for compliance with antihypertensive treatment. The vast majority of participants stated that they order an electrocardiogram (95.9%), laboratory tests (83.6%), and urinalysis (71.2%) in patients attending the ED with BP exceeding 180/110 mmHg. By contrast, only 26.1% always or almost always order a fundoscopic examination, whereas 23.3% stated that they never or almost never ask for this examination. Calcium channel blockers would be the first drug to be administered by study participants (63%) to patients presenting with BP exceeding 180/110 mmHg without acute damage to target organs, followed by captopril sublingually (17.8%), renin-angiotensin-aldosterone axis inhibitors (8.2%), and benzodiazepines (6.8%). Conclusions: The diagnostic approach and therapeutic management of patients attending the ED with hypertensive urgencies or emergencies may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines, even in a relatively homogeneous sample of tertiary hospital physicians. More efforts are warranted to educate physicians on this important clinical issue.