Skip to main content
Log in

Hypertension Urgencies and Emergencies: The GEAR Project

  • Review article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Acute elevations in blood pressure (BP), usually defined as ≥ 180/110 mmHg, may present with highly heterogeneous profiles ranging from absence of symptoms to life-threatening target organ damage. In most recent years the diagnostic approach and the treatment of hypertension have gained interest by patients and physicians. The GEAR project (Gestione delle Emergenze e urgenze in ARea critica, management of hypertensive emergencies and hypertensive urgencies in the emergency setting) was proposed by the group of Young Investigators of the Italian Society of Hypertension as a survey aimed to evaluate the awareness, diagnosis and treatment of hypertensive emergencies and urgencies in Italy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Whelton PK, Carey RM, Aronow WS, Ovbiagele B, Casey DE, Smith SC, et al. 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 T; 2017. doi:https://doi.org/10.1161/HYP.0000000000000065/-/DC1.

  2. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I, Authors/Task Force Members. 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. J Hypertens. 2018;36(10):1953–2041.

    Article  CAS  Google Scholar 

  3. van den Born BH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E, Mahfoud F, Amraoui F, Persu A, Kahan T, Agabiti Rosei E, de Simone G, Gosse P, Williams B. ESC Council on hypertension position document on the management of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother. 2019;5(1):37–46.

    Article  Google Scholar 

  4. Janke AT, Mcnaughton CD, Brody AM, Welch RD, Levy PD. Trends in the incidence of hypertensive emergencies in US emergency departments From 2006 to 2013. J Am Heart Assoc. 2016;5:1–8.

    Article  Google Scholar 

  5. Paini A, Aggiusti C, Bertacchini F, Agabiti Rosei C, Maruelli G, Arnoldi C, et al. Definitions and epidemiological aspects of hypertensive urgencies and emergencies. High Blood Press Cardiovasc Prev. 2018;25:241–4.

    Article  CAS  Google Scholar 

  6. Lip GY, Beevers M, Beevers G. The failure of malignant hypertension to decline: a survey of 24 years’ experience in a multiracial population in England. J Hypertens. 1994;12:1297–305.

    Article  CAS  Google Scholar 

  7. Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27:144–7.

    Article  CAS  Google Scholar 

  8. Pinna G, Pascale C, Fornengo P, Arras S, Piras C, Panzarasa P, et al. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS One. 2014;9:1–6.

    Google Scholar 

  9. Saladini F, Mancuso C, Bertacchini F, Spannella F, Maloberti A, Giavarini A, Rosticci M, Bruno RM, Pucci G, Grassi D, Pengo M, Muiesan ML. 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 Int Med. 2019. https://doi.org/10.1016/j.ejim.2019.10.004.

    Article  Google Scholar 

  10. Patel KK, Young L, Howell EH, Hu B, Rutecki G, Thomas G, et al. Characteristics and outcomes of patients presenting with hypertensive urgency in the office setting. JAMA Intern Med. 2016;44195:981–8.

    Article  Google Scholar 

  11. Vlcek M, Bur A, Woisetschläger C, Herkner H, Laggner AN, Hirschl MM. Association between hypertensive urgencies and subsequent cardiovascular events in patients with hypertension. J Hypertens. 2008;26:657–62.

    Article  CAS  Google Scholar 

  12. Merlo C, Bally K, Tschudi P, Martina B, Zeller A. Management and outcome of severely elevated blood pressure in primary care. Swiss Med Wkly. 2012;142:1–6.

    Google Scholar 

  13. Roubsanthisuk W, Wongsurin U, Buranakitjaroen P. Hypertensive emergencies remain a clinical problem and are associated with high mortality. J Med Assoc Thai. 2010;93(Suppl 1):54–61.

    Google Scholar 

  14. Jacobs Z. Reducing unnecessary treatment of asymptomatic elevated blood pressure with intravenous medications on the general internal medicine wards: a quality improvement initiative. J Hosp Med. 2019;14:144.

    Article  Google Scholar 

  15. Kaya A, Tatlisu MA, Kaplan T, Pharm K, Yildirimturk O, Gungor B, et al. Pharmacology in emergency medicine. J Emerg Med. 2016;50:108–15.

    Article  Google Scholar 

  16. Kaplan NM. Management of hypertensive emergencies. Lancet. 1994;344(12):1994.

    Google Scholar 

  17. Muiesan ML, Salvetti M, Paini A, Bertacchini F, Stassaldi D, Aggiusti C, Agabiti Rosei C, et al. Acute blood pressure elevation: therapeutic approach. Pharmacol Res. 2018;130:180–90.

    Article  Google Scholar 

  18. Muiesan ML, Salvetti M, Paini A, Riviera M, Pintossi C, Bertacchini F, et al. Ocular fundus photography with a smartphone device in acute hypertension. J Hypertens. 2017;35(8):1660–5. https://doi.org/10.1097/HJH.0000000000001354.

    Article  CAS  PubMed  Google Scholar 

  19. Peacock WF, Chandra A, Char D, Collins S. Clevidipine in acute heart failure: results of the A study of blood pressure control in acute heart failure: a pilot study (PRONTO). Am Heart J. 2014;167:529–36.

    Article  CAS  Google Scholar 

  20. Alviar CL, Gutierrez A, Cho L, Krishnaswamy A, Saleh A, Lincoff MA, et al. Clevidipine as a therapeutic and cost-effective alternative to sodium nitroprusside in patients with acute aortic syndromes. Eur Heart J Acute Cardiovasc Care. 2018. https://doi.org/10.1177/2048872618777919.

    Article  PubMed  Google Scholar 

  21. Rosenfeldt Z, Conklen K, Jones B, Ferrill D, Deshpande M, Siddiqui FM. Comparison of nicardipine with clevidipine in the management of hypertension in acute cerebrovascular diseases. J Stroke Cerebrovasc Dis. 2018;27:2067–73.

    Article  Google Scholar 

  22. Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276:1328–31.

    Article  CAS  Google Scholar 

  23. Brody A, Rahman T, Reed B, Millis S, Ference B, Flack JM, Levy PD. Safety and efficacy of antihypertensive prescription at emergency department discharge. Acad Emerg Med. 2015;22:632–5.

    Article  Google Scholar 

  24. Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BH, Regitz-Zagrosek V, de Simone G. Peripartum management of hypertension. A position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2019. https://doi.org/10.1093/ehjcvp/pvz082).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria Lorenza Muiesan.

Ethics declarations

Conflict of interest

Authors state no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salvetti, M., Bertacchini, F., Saccà, G. et al. Hypertension Urgencies and Emergencies: The GEAR Project. High Blood Press Cardiovasc Prev 27, 129–132 (2020). https://doi.org/10.1007/s40292-020-00372-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-020-00372-3

Keywords

Navigation