{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:48:58Z","timestamp":1788371338720,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T00:00:00Z","timestamp":1653436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 &lt; 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 &lt; 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 &lt; 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\u2019s specialty. Educational initiatives should be done to standardize treatment protocols and to improve medical knowledge.<\/jats:p>","DOI":"10.3390\/jcm11112986","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T08:50:22Z","timestamp":1653555022000},"page":"2986","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["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\u2014Data from Gear (Gestione Dell\u2019emergenza e Urgenza in ARea Critica) Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1846-4738","authenticated-orcid":false,"given":"Francesca","family":"Saladini","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Padova, 35128 Padova, Italy"},{"name":"Cardiology Unit, Cittadella Town Hospital, Via Casa di Ricovero 40, 35013 Cittadella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6690-1408","authenticated-orcid":false,"given":"Costantino","family":"Mancusi","sequence":"additional","affiliation":[{"name":"Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Bertacchini","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Brescia-ASST Spedali Civili di Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Spannella","sequence":"additional","affiliation":[{"name":"Internal Medicine and Geriatrics, IRCCS-INRCA, 60127 Ancona, Italy"},{"name":"Department of Clinical and Molecular Sciences, University \u201cPolitecnica delle Marche\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2612-6264","authenticated-orcid":false,"given":"Alessandro","family":"Maloberti","sequence":"additional","affiliation":[{"name":"Cardiology 4, ASST Niguarda Hospital, 20121 Milan, Italy"},{"name":"School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Giavarini","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Rosticci","sequence":"additional","affiliation":[{"name":"Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6107-3356","authenticated-orcid":false,"given":"Rosa Maria","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-859X","authenticated-orcid":false,"given":"Giacomo","family":"Pucci","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, University of Perugia, Terni University Hospital, 06132 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1005-4689","authenticated-orcid":false,"given":"Davide","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Public Health, University of Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4657-9172","authenticated-orcid":false,"given":"Martino","family":"Pengo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4007-9441","authenticated-orcid":false,"given":"Maria Lorenza","family":"Muiesan","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Brescia-ASST Spedali Civili di Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1001\/jama.289.19.2560","article-title":"The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report","volume":"289","author":"Chobanian","year":"2003","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.ahj.2009.07.020","article-title":"Practice patterns, outcomes, and end-organ dysfunction for patients with acute severe hypertension: The Studying the Treatment of Acute hyperTension (STAT) registry","volume":"158","author":"Katz","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart Disease and Stroke Statistics\u20142018 Update: A Report from the American Heart Association","volume":"137","author":"Benjamin","year":"2018","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11906-014-0515-z","article-title":"Cardiovascular hypertensive emergencies","volume":"17","author":"Papadopoulos","year":"2015","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_5","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/ehjcvp\/pvy032","article-title":"ESC Council on hypertension position document on the management of hypertensive emergencies","volume":"5","author":"Lip","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1097\/HJH.0000000000001940","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension","volume":"36","author":"Williams","year":"2018","journal-title":"J. Hypertens."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International Society of Hypertension Global Hypertension Practice Guidelines","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2459\/JCM.0000000000000223","article-title":"An update on hypertensive emergencies and urgencies","volume":"16","author":"Muiesan","year":"2015","journal-title":"J. Cardiovasc. Med."},{"key":"ref_10","first-page":"CD003653","article-title":"Pharmacological interventions for hypertensive emergencies","volume":"2008","author":"Perez","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1590\/S0066-782X2004001400004","article-title":"Hypertensive crisis profile. Prevalence and clinical presentation","volume":"83","author":"Martin","year":"2004","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1161\/01.HYP.27.1.144","article-title":"Hypertensive urgencies and emergencies. Prevalence and clinical presentation","volume":"27","author":"Zampaglione","year":"1996","journal-title":"Hypertension"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/hr.2010.245","article-title":"Hypertensive crisis: Clinical-epidemiological profile","volume":"34","author":"Kuniyoshi","year":"2011","journal-title":"Hypertens. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pinna, G., Pascale, C., Fornengo, P., Arras, S., Piras, C., Panzarasa, P., Carmosino, G., Franza, O., Semeraro, V., and Lenti, S. (2014). Hospital admissions for hypertensive crisis in the emergency departments: A large multicenter Italian study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0093542"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/HJH.0000000000002213","article-title":"Hypertensive emergencies and urgencies: A single-centre experience in Northern Italy 2008\u20132015","volume":"38","author":"Salvetti","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ejim.2019.10.004","article-title":"Diagnosis and treatment of hypertensive emergencies and urgencies among Italian emergency and intensive care departments. Results from an Italian survey: Progetto GEAR (Gestione dell\u2019Emergenza e urgenza in ARea critica)","volume":"71","author":"Saladini","year":"2020","journal-title":"Eur. J. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1093\/eurheartj\/eht151","article-title":"2013 ESH\/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)","volume":"34","author":"Mancia","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1111\/echo.14451","article-title":"Point-of-care ultrasound with pocket-size devices in emergency department","volume":"36","author":"Mancusi","year":"2019","journal-title":"Echocardiography"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1093\/eurheartj\/ehw164","article-title":"Ultrasound of extravascular lung water: A new standard for pulmonary congestion","volume":"37","author":"Picano","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/ejechocard\/jeq184","article-title":"The use of pocket-size imaging devices: A position statement of the European Association of Echocardiography","volume":"12","author":"Sicari","year":"2011","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/sj.jhh.1002324","article-title":"The dangers of immediate-release nifedipine in the emergency treatment of hypertension","volume":"22","author":"Burton","year":"2008","journal-title":"J. Hum. Hypertens."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s004670200006","article-title":"Evaluation of the safety of short-acting nifedipine in children with hypertension","volume":"17","author":"Egger","year":"2002","journal-title":"Pediatr. Nephrol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1046\/j.1440-1681.1999.03046.x","article-title":"Sublingual nifedipine in elderly patients: Even a low dose induces myocardial ischaemia","volume":"26","author":"Ishibashi","year":"1999","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_24","first-page":"46","article-title":"Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial doppler ultrasonography during hypertensive crisis","volume":"12","author":"Gemici","year":"2003","journal-title":"Blood Press."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/sj.jhh.1000854","article-title":"Comparison between isosorbide dinitrate aerosol and nifedipine in the treatment of hypertensive emergencies","volume":"13","year":"1999","journal-title":"J. Hum. Hypertens."},{"key":"ref_26","first-page":"151","article-title":"The effect of Nifedipine on postpartum blood loss in patients with pregnancy induced hypertension","volume":"35","author":"Yang","year":"2000","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/00005344-199903000-00019","article-title":"Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase","volume":"33","author":"Sobrino","year":"1999","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1002\/j.1875-9114.1998.tb03945.x","article-title":"Another report of adverse reactions to immediate-release nifedipine","volume":"18","author":"Fami","year":"1998","journal-title":"Pharmacotherapy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1001\/jama.1996.03540160050032","article-title":"Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies?","volume":"276","author":"Grossman","year":"1996","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society Clinical Practice Guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1055\/s-0031-1295460","article-title":"Factors affecting the aldosterone\/renin ratio","volume":"44","author":"Stowasser","year":"2012","journal-title":"Horm. Metab. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1001\/jamainternmed.2016.1509","article-title":"Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting","volume":"176","author":"Patel","year":"2016","journal-title":"JAMA Intern. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/11\/2986\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:18:38Z","timestamp":1760138318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/11\/2986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,25]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcm11112986"],"URL":"https:\/\/doi.org\/10.3390\/jcm11112986","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,25]]}}}