[Diagnostic and therapeutic procedures by doctors for patients in a hypertensive crisis. An inquiry in 56 internal medicine clinics].
OBJECTIVE
Despite official guidelines on the diagnosis and treatment of hypertensive crisis, the extent to which they are being followed in routine medical practice is unknown. This study was undertaken to discover how hospital doctors were handling cases of hypertensive crisis (HC).


METHODS
Physicians were requested to participate in a multiple-choice questionnaire study, relating to the diagnosis of HC, any emergency diagnosis and choice of antihypertensive drugs, these questionnaires to be distributed among the medical staff. Ultimately 463 questionnaires (one per doctor) were sent out and 325 were completed (response rate of 70%).


RESULTS
The most frequently mentioned blood pressure values characteristics for HC were > 200 systolic and > 120 diastolic. 160/90 was given most often as the therapeutic goal, which most doctors wanted to reach in an HC within 30 to 60 min. The calcium-antagonist nifedipine was the drug of first choice for almost all clinical presentations. Second was intravenously urapidil, an alpha-agonist. Nitroglycerin was named as first choice only for pulmonary oedema or myocardial infarction. In everyone of the stated conditions most doctors were eager to avoid using beta-blockers. As for the drug of first choice in associated myocardial infarction, 111 doctors named nifedipine, 28 wanted to avoid it and 45 considered it contraindicated.


CONCLUSIONS
These data show a marked discrepancy between recommended guidelines and actual practice in the management of hypertensive crisis.
Wenzel
U O
UO
Abteilung für Nephrologie, Universitäts-Krankenhauses Eppendorf, Hamburg, Berlin. Wenzel@plexus.uke.uni-hamburg.de
Stahl
R A
RA
Grieshaber
M
M
Schwietzer
G
G
D000208:Acute Disease; D000286:Administration, Sublingual; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D000075202:Contraindications; D004630:Emergencies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D007275:Injections, Intravenous; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D009543:Nifedipine / Q000008:administration & dosage / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000150:complications / Q000188:drug therapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D010879:Piperazines; D014665:Vasodilator Agents; C015568:urapidil; D005996:Nitroglycerin; D009543:Nifedipine
Diagnostisches und therapeutisches Vorgehen von Arzten bei Patienten mit hypertensiver Krise. Eine Umfrage an 56 internistischen Kliniken.