Treating hypertensive crises between guidelines and real world: the anti-hypertensive role of anti-anxiety drugs

Hypertension is a common clinical problem, encountered in various clinical settings. Inevitably, a small proportion of patients with hypertension will develop hypertensive crisis at some point. Hypertensive crises can be divided into hypertensive emergency (E) or urgency (U) according to the presence or lack of acute target organ damage. Both hypertensive E and U can be associated with significant morbidity and mortality. The choice of therapeutic intervention should be based on evaluation of a number of factors, such as clinical picture, the patients’ age, the presence of comorbidities, and other ongoing therapies. We enrolled 457 patients who were referred to the Pavia Emergency Department (ED) during 2014 because of excessive hypertension (170 and/or 110 mmHg; 113 E and 344 U). We analyzed the clinical data and the drugs prescribed and assumed, comparing the “real world” management of hypertensive crisis with guidelines indications. The prevalence of women was higher than expected (62,1%) but above all, the use of anxiolytic drugs was much more common (45,9%) than expected or suggested by guidelines. The most used drug administered was clonidine (57.7% of treated patients). The mean blood pressure (BP) reduction (nearly -40 and -20 mmHg for systolic and diastolic pressure respectively) was greater and faster than suggested by guidelines. During the following months, 63 patients were readmitted to the ED for new episodes of acute BP increase. In many patients the cause of the BP elevation is unknown and anxiety may play an important role. In these patients antianxiety treatment may be beneficial. We tried to find the reasons of this apparently inappropriate but effective approach.