We agree with Drs. La Regina and del Prato that problems in medicine can be approached from a variety of perspectives, although some basic directions should be shared by physicians working in different fields. There is no doubt that arterial hypertension is today a diagnosis that rarely leads to hospitalisation. There are however occasions characterised by a high risk for the patient, when this will be necessary, as in cases of pulmonary oedema or transient ischaemic cerebral attack. Concerning the patients without life-threatening hypertensive crises, the current Guidelines for the management of high blood pressure provide clear indications, suggesting the need for repeated visits to confirm the presence and the severity of an elevation of blood pressure, and to assess the global risk profile of the patient and the presence of target organ damage. In most cases there is no need to hasten the start of antihypertensive treatment until the diagnostic process has been completed. The time interval before starting treatment is obviously a function of the patient’s risk level. An appropriate diagnostic work-up should also lead to identification of cases with secondary hypertension. Primary Care Physicians (PCP) have the duty to start management of patients with hypertension, in cooperation with specialised centres that provide all the necessary support for definition of the patient’s risk profile and organ damage. This approach, accompanied by a good relationship between the patient and the physician, will also reduce patients’ utilisation of the emergency service for false hypertensive crisis, often due to anxiety and sympathetic hyper-reactivity.

The diagnostic work-up of the patient should not be carried out in the Emergency Department, but should be part of the routine interaction between PCP and specialists.