Management of Hypertensive Urgencies and Emergencies in the Emergency Department Comparison of Diagnostic and Therapeutic Approach Among Physicians of Different Specialties

Objective: Hypertensive urgencies (HU) and hypertensive emergencies (HE) are common causes for presentation to the Emergency Department (ED). This study aimed to investigate whether the diagnostic and therapeutic approach of HU and HE differs among medical specialties involved in their management. Design and method: A structured questionnaire was distributed to physicians working in the EDs of three tertiary hospitals. The survey evaluated knowledge of definitions, adherence to diagnostic protocols, and therapeutic preferences in HU and HE. Results: Responses from 146 physicians (56.9% internists, 22.5% cardiologists, and 18.0% general practitioners) were analyzed. Regarding the definition of hypertensive urgency/emergency, cardiologists were more likely to correctly identify the blood pressure (BP) threshold of 180/110 mmHg (58.8%) compared to internists (51.9%) and general practitioners (51.9%, p=0.050). Significant differences were observed in the diagnostic work-up for patients with BP >=180/110 mmHg. Cardiologists systematically ordered urinalysis (38.2%) and fundoscopy (2.9%) significantly less frequently than internists (72.7% and 29.9% respectively) and general practitioners (55.6% and 18.5%, p=0.024 and p<0.001). Regarding clinical management, calcium channel blockers were the most common initial oral treatment for urgencies across all groups. However, cardiologists were more stringent regarding discharge criteria, with 82.4% requiring BP <160/100 mmHg, compared to 53.2% of internists and 63.0% of general practitioners (p=0.012). For malignant hypertension, intravenous labetalol was the primary choice for internists (48.1%), while cardiologists significantly preferred intravenous sodium nitroprusside (38.2% vs 11.7% for internists and 0% for general practitioners, p=0.002). Adherence to proper BP measurement techniques, as defined by current hypertension guidelines, was low across all specialties (8.8% to 14.8% always compliant). Conclusions: The diagnostic and therapeutic management of hypertensive crises in the ED deviates significantly among medical specialties. These findings underscore the need for targeted, continuous medical education and the implementation of standardized protocols to harmonize the management of hypertensive urgencies and emergencies.