Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Deviations in the diagnostic and management approach of hypertensive urgencies and emergencies in routine clinical practice as compared to the guidelines: a survey of physicians in tertiary hospitals

Journal of Human Hypertension (2025)Cite this article

Subjects

Abstract

Elevated blood pressure (BP) ≥ 180/110 mmHg is a frequent cause of attendance to the Emergency Department (ED). Current hypertension guidelines clearly define a diagnostic and management approach for hypertensive urgencies (HUs) and emergencies (HEs). The aim of this study was to report on physicians’ routine clinical practice regarding diagnosis and treatment of HUs and HEs. This observational cross-sectional study was conducted in tertiary hospitals of Thessaloniki, Greece. A specifically designed questionnaire was distributed to physicians working in the ED, who were actively implicated in the management of patients with HUs/HEs. Among 146 responders, only 54.1% correctly reported that HUs and HEs are characterized by an increase in BP ≥ 180/110 mmHg. Less than half (48.6%) stated that they routinely check for compliance with antihypertensive treatment. The vast majority routinely order an electrocardiogram (91.8%) and laboratory tests (79.5%) in patients attending the ED with BP ≥ 180/110 mmHg, but this percentage dropped to 61.0% for urinalysis. Only 21.2% routinely order a fundoscopic examination. Calcium channel blockers would be the first drug to administer by 63.0% of study participants to HUs, whereas only 40.4% would choose intravenous labetalol as the first-line antihypertensive medication for malignant hypertension. Subgroup analysis revealed significant differences according to the most prevalent ED specialties of Internal Medicine, General Practice and Cardiology. The diagnostic approach and therapeutic management of HUs or HEs may deviate significantly in real-life clinical practice compared to current recommendations by international hypertension guidelines. More efforts are warranted to educate physicians on this important clinical issue.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Definition and initial assessment of hypertensive urgencies and emergencies.
Fig. 2: Further diagnostic steps.
Fig. 3: Management of hypertensive urgencies and emergencies.

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Kario K, Okura A, Hoshide S, Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res. 2024;47:1099–102.

    Article  PubMed  Google Scholar 

  2. Magnussen C, Alegre-Diaz J, Al-Nasser LA, Amouyel P, et al. Global effect of cardiovascular risk factors on lifetime estimates. N Engl J Med. 2025;393:125–38.

    Article  PubMed  Google Scholar 

  3. Anyfanti P, Gavriilaki E, Douma S Evaluating the true prevalence of resistant hypertension. Hypertension 2011; 58. https://doi.org/10.1161/HYPERTENSIONAHA.111.178111.

  4. Anyfanti P, Gkaliagkousi E, Triantafyllou A, Koletsos N, Gavriilaki E, Galanopoulou V, et al. Hypertension in rheumatic diseases: prevalence, awareness, treatment, and control rates according to current hypertension guidelines. J Hum Hypertens. 2021;35:419–27.

    Article  PubMed  Google Scholar 

  5. Mallamaci F, Torino C, Sarafidis P, Ekart R, Loutradis C, Siamopoulos K, et al. Treatment-resistant hypertension in the hemodialysis population: a 44-h ambulatory blood pressure monitoring-based study. J Hypertens. 2020;38:1849–56.

    Article  PubMed  Google Scholar 

  6. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the european society of hypertension: endorsed by the international society of hypertension (ISH) and the European renal associa. J Hypertens. 2023;41:1874–2071.

    Article  PubMed  Google Scholar 

  7. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45:3912–4018.

    Article  PubMed  Google Scholar 

  8. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356:411–7.

    Article  PubMed  Google Scholar 

  9. van den Born B-JH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E, et al. ESC Council on hypertension position document on the management of hypertensive emergencies. Eur Hear J Cardiovasc Pharmacother. 2019;5:37–46.

    Article  Google Scholar 

  10. Mancia G, Kreutz R, Brunstr M, Burnier M, Grassi G, Januszewicz A et al. Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41:1874–2071.

  11. Astarita A, Covella M, Vallelonga F, Cesareo M, Totaro S, Ventre L, et al. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis. J Hypertens. 2020;38:1203–10.

    Article  PubMed  Google Scholar 

  12. Siddiqi TJ, Usman MS, Rashid AM, Javaid SS, Ahmed A, Clark D, et al. Clinical outcomes in hypertensive emergency: a systematic review and meta-analysis. J Am Heart Assoc. 2023;12:e029355.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Guiga H, Decroux C, Michelet P, Loundou A, Cornand D, Silhol F, et al. Hospital and out-of-hospital mortality in 670 hypertensive emergencies and urgencies. J Clin Hypertens. 2017;19:1137–42.

    Article  Google Scholar 

  14. Salvetti M, Paini A, Colonetti E, Tarozzi L, Bertacchini F, Aggiusti C, et al. Hypertensive emergencies and urgencies: a single-centre experience in Northern Italy 2008-2015. J Hypertens. 2020;38:52–58.

    Article  PubMed  Google Scholar 

  15. Fragoulis C, Dimitriadis K, Siafi E, Iliakis P, Kasiakogias A, Kalos T, et al. Profile and management of hypertensive urgencies and emergencies in the emergency cardiology department of a tertiary hospital: a 12-month registry. Eur J Prev Cardiol. 2022;29:194–201.

    Article  PubMed  Google Scholar 

  16. Muiesan ML, Rosei EA, Borghi C, De Luca N, Ghiadoni L, Grassi G, et al. The UrgeRe (Urgenze ipertensive: un progetto educazionale fondato sulla vita reale, hypertensive urgencies: a project in the real world) project. High blood Press Cardiovasc. 2021;28:151–7.

    Article  Google Scholar 

  17. Buso G, Weber T, Fragoulis C, Grassi G, Agabiti-Rosei C, Delles C, et al. Diagnostic and therapeutic approach to acute blood pressure elevations: results of an international survey among excellence centres of the European society of hypertension. Blood Press. 2025;34:2535689.

    Article  PubMed  Google Scholar 

  18. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990–2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398:957–80.

    Article  Google Scholar 

  19. Mullins PM, Levy PD, Mazer-Amirshahi M, Pines JM. National trends in U.S. emergency department visits for chief complaint of hypertension (2006-15). Am J Emerg Med. 2020;38:1652–7.

    Article  PubMed  Google Scholar 

  20. Saladini F, Mancusi C, Bertacchini F, Spannella F, Maloberti A, Giavarini A, et al. Diagnosis and treatment of hypertensive emergencies and urgencies among Italian emergency and intensive care departments. Results from an Italian survey: progetto GEAR (Gestione dell’Emergenza e urgenza in ARea critica). Eur J Intern Med. 2020;71:50–56.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Third Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiota Anyfanti, Christina Antza, Georgios Styliadis, Eugenia Gkaliagkousi & Vasilios Kotsis

  2. Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Eleni Karlafti

  3. Emergency Department, Hippokration Hospital, Thessaloniki, Greece

    Eleni Chovarda

  4. Third Cardiology Department, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantinos Triantafyllou

Authors
  1. Panagiota Anyfanti
    View author publications

    Search author on:PubMed Google Scholar

  2. Christina Antza
    View author publications

    Search author on:PubMed Google Scholar

  3. Eleni Karlafti
    View author publications

    Search author on:PubMed Google Scholar

  4. Eleni Chovarda
    View author publications

    Search author on:PubMed Google Scholar

  5. Konstantinos Triantafyllou
    View author publications

    Search author on:PubMed Google Scholar

  6. Georgios Styliadis
    View author publications

    Search author on:PubMed Google Scholar

  7. Eugenia Gkaliagkousi
    View author publications

    Search author on:PubMed Google Scholar

  8. Vasilios Kotsis
    View author publications

    Search author on:PubMed Google Scholar

Contributions

PA, CA and EG contributed to conception and design of the study. PA, EK, EC, KT performed data collection. PA and CA performed statistical analysis. PA, EK and GS performed the literature searching, wrote and prepared the original draft of the manuscript. PA and CA prepared the figures and tables. VK reviewed, edited and supervised the final version of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Corresponding author

Correspondence to Panagiota Anyfanti.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved from Institutional Review Board of Papageorgiou Hospital, Thessaloniki, Greece (protocol code 392/17-12-24, date of approval 17 December 2024). Informed consent was obtained from all participants. All methods were performed in accordance with the relevant guidelines and regulations.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anyfanti, P., Antza, C., Karlafti, E. et al. Deviations in the diagnostic and management approach of hypertensive urgencies and emergencies in routine clinical practice as compared to the guidelines: a survey of physicians in tertiary hospitals. J Hum Hypertens (2025). https://doi.org/10.1038/s41371-025-01101-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41371-025-01101-w

Search

Advanced search

Quick links