What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertensive urgency and emergency (n=665). Intervention: Physician specialty vs. Other specialties. Primary outcome: Prescription of s.l. nifedipine (p=<0.001).

What does this research mean for the field?

Physician specialty significantly influences the management of hypertensive emergencies, with cardiologists prescribing less i.v. labetalol and more s.l. nifedipine compared to other specialists. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate differences in the diagnosis, clinical evaluation, and therapeutic management of hypertensive emergencies and urgencies across various medical departments in Italy.

May 25, 2022Journal of Clinical MedicineOpen Access

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

Q: What are the key findings of this study?

Management of hypertensive emergencies and urgencies varied significantly by physician specialty, with cardiologists reporting the highest prescription rate of sublingual nifedipine (43.1%, p < 0.001).

Q: What does this research mean for the field?

Physician specialty significantly influences the management of hypertensive emergencies, with cardiologists prescribing less i.v. labetalol and more s.l. nifedipine compared to other specialists. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate differences in the diagnosis, clinical evaluation, and therapeutic management of hypertensive emergencies and urgencies across various medical departments in Italy.

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Key result

Cardiologists prescribe sublingual nifedipine most often for hypertensive crises, reaching ~43% of cases.

P<0.001
n=665

Why the study?

Diagnosis and treatment of hypertensive emergencies and urgencies may vary according to the treating physicians and clinical setting.

Comparison

Physician work setting and specialty

Design

Survey study using a 23-item questionnaire

Authors

FSFrancesca SaladiniPreventive Cardiology CMCostantino MancusiGeneral / Preventive / Lipids FBFabio BertacchiniAzienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia

Discussion

Member takes

Implication

Specialty differences drive variable nifedipine use in hypertensive crises; leaves open whether education improves guideline adherence.

Key Points

To evaluate differences in the diagnosis, clinical evaluation, and therapeutic management of hypertensive emergencies and urgencies across various medical departments in Italy.
A 23-item voluntary web survey developed by the Italian Society of Hypertension was administered to members of Italian emergency and hypertension societies between December 2017 and March 2018.
Responses were analyzed using chi-square tests for categorical variables and Student's t-tests for continuous variables to compare departments and qualification levels.
Diagnostic approaches varied significantly: cardiologists more often attributed epistaxis (55.2%, p = 0.012) and conjunctival hemorrhage (70.7%, p < 0.0001) to emergency, but less frequently considered dyspnea (67.2%, p = 0.014) or chest pain (72.4%, p = 0.001), while intensive care doctors were most familiar with lung ultrasound (50%, p = 0.004).
Therapeutic strategies differed across specialties: cardiologists reported the lowest rate of intravenous labetalol use (39.6%, p = 0.003) and the highest prescription of sublingual nifedipine (43.1%, p < 0.001).
Knowledge of basic definitions for hypertensive emergencies and urgencies did not differ across specialties, but blood pressure measurement techniques (p < 0.004) and cuff size availability varied substantially.

Study Design

Type

Cross-Sectional (n=665)

Structured PICO

Population

665 Italian physicians from various specialties completed a survey on the diagnosis and management of hypertensive urgencies and emergencies.

Outcome

Differences in diagnosis, management, and treatment of hypertensive emergencies and urgencies according to the work setting and specialty of the physicians

Main Result

p-value: p=<0.001

Management and treatment of hypertensive emergencies and urgencies vary significantly according to the doctor's specialty, highlighting the need for standardized protocols and educational initiatives to improve guideline adherence.

Limitations

Descriptive analysis based on an online survey, cannot provide evidence of causation
Response rate was 55.42%, which might not be representative of the wider community of Italian physicians
Answers may reflect ideal practice rather than real everyday clinical practice
Unable to distinguish between physicians working in rural or urban areas
Survey was spread before the release of the 2018 ESC/ESH hypertension guidelines
Small number of responders working in internal medicine and IC or stroke units
Survey was not spread to gynecologists, lacking data on eclampsia/preeclampsia
Descriptive analysis only, cannot provide evidence of causation
Rate of response was not very high (55.42%)

Cite This Study

Saladini et al. (2022) conducted a cross-sectional in Hypertensive urgency and emergency (n=665). Physician specialty vs. Other specialties was evaluated on Prescription of s.l. nifedipine (p=<0.001). Management of hypertensive emergencies and urgencies varied significantly by physician specialty, with cardiologists reporting the highest prescription rate of sublingual nifedipine (43.1%, p < 0.001).

synapsesocial.com/papers/6a1c1fc2ea84844e355f7a9d https://doi.org/10.3390/jcm11112986

Topics

Hypertension management

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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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider