DIAGNOSTIC AND THERAPEUTIC MEASURES TAKEN BY DOCTORS ON PATIENTS IN AHYPERTENSIVE CRISIS - AN INQUIRY OF 56 MEDICAL-CENTERS

Background and objective: Despite official guidelines on the diagnosis and treatment of hypertensive crisis, the extent to which they are be ing followed in routine medical practice is unknown. This study was un dertaken to discover how hospital doctors were handling cases of hyper tensive crisis (HC). Material and methods: Physicians were requested t o participate in a multiple-choice questionnaire study, relating to th e diagnosis of HC, any emergency diagnosis and choice of antihypertens ive drugs, these questionnaires to be distributed among the medical st aff. Ultimately 463 questionnaires tone per doctor) were sent out and 325 were completed (response rate of 70%). Results: The most frequentl y mentioned blood pressure values characteristic for HC were > 200 sys tolic and > 120 diastolic. 160/90 was given most often as the therapeu tic goal, which most doctors wanted to reach ire an HC within 30 to 60 min. The calcium-antagonist nifedipin was the drug of first choice fo r almost all clinical presentations. Second was intravenously urapidil , an alpha-agonist. Nitroglycerin was named as first choice only for p ulmonary oedema or myocardial infarction. In everyone of the stated co nditions most doctors were eager to avoid using beta-blockers. As for the drug of first choice in associated myocardial infarction, 111 doct ors named nifedipin, 28 wanted to avoid it and 45 considered it contra indicated. Conclusion: These data show a marked discrepancy between re commended guidelines and actual practice in the management of hyperten sive crisis.