Saladini Francesca, Mancusi Costantino, Bertacchini Fabio, Spannella Francesco, Maloberti Alessandro, Giavarini Alessandra, Rosticci Martina, Bruno Rosa Maria, Pucci Giacomo, Grassi Davide, Pengo Martino, Muiesan Maria Lorenza
Department of Medicine, University of Padova, 35128 Padova, Italy.
Cardiology Unit, Cittadella Town Hospital, Via Casa di Ricovero 40, 35013 Cittadella, Italy.
J Clin Med. 2022 May 25;11(11):2986. doi: 10.3390/jcm11112986.
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.
高血压急症（HE）和亚急症（HU）的诊断与治疗可能因参与的医生及治疗环境而异。本研究的目的是根据医生的工作环境调查HE和HU管理方面的差异。方法：意大利高血压学会的年轻研究人员编制了一份包含23个条目的问卷，通过电子邮件邀请意大利急诊医学和高血压领域科学学会的成员参与。结果：共收集到665份问卷。在HE和HU的正确定义或可能导致血压急性升高的药物调查方面未发现差异。根据环境不同，用于评估血压值的技术（p < 0.004）和可用袖带的尺寸有所不同。心脏病专家更频繁地将鼻出血（55.2%，p = 0.012）和结膜出血（70.7%，p < 0.0001）定义为HE的可能表现，而很少将呼吸困难（67.2%，p = 0.014）或胸痛（72.4%，p = 0.001）视为可能表现。重症监护（IC）病房医生更熟悉肺部超声检查（50%，p = 0.004）。在治疗方面，心脏病专家报告静脉注射拉贝洛尔的处方率最低（39.6%，p = 0.003），舌下含服硝苯地平的处方率最高（43.1%，p < 0.001）。出院后，几乎所有类别的医生都要求进行家庭血压评估或转诊至全科医生，而高血压中心评估或动态血压监测的建议较少。结论：HE和HU的管理与治疗可能因医生专业不同而有所差异。应开展教育举措以规范治疗方案并提高医学知识水平。
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