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More on hypertension and reduced renal function

Internal and Emergency Medicine
Publication Date
DOI: 10.1007/s11739-007-0015-0
  • Letters To The Editor
  • Medicine


62 More on hypertension and reduced renal function M. La Regina • C. del Prato M. La Regina (�) • C. del Prato U.O.C Pronto Soccorso e Medicina d’Urgenza Ospedale Civile Sant’Andrea, Via V. Veneto 197, I-19124 La Spezia, Italy e-mail: [email protected] Received: 8 August 2006 / Accepted in original form: 30 August 2006 / Published online: 31 March 2007 First of all, compliments for the new and wider “dress and mission” of the journal of our society. As it is destined for a double audience, it is no surprise that each paper will natural- ly be seen from two different points of view. Even though many of the Italian emergency physicians (EP), at the begin- ning of Italian speciality courses in emergency medicine (EM), started out in Internal Medicine, as they have been working in EM they have changed quickly their clinical style because of unstable clinical conditions of some patients, and more pressing rhythms that have to be faced. One must devel- op a quicker, simpler and more pragmatic way of thinking and acting: does the patient have a life-threatening disease or not? Does the patient need hospitalisation or is it safe for a prima- ry care physician (PCP) to manage the problem on an outpa- tient basis? The introduction of cost/benefit ratios in medicine is creating another pressure: not to admit the patient. As internists we read with great interest the case report in the first issue [1], but as physicians working in EM, we imme- diately transferred its contents to our practice. How many patients with increased blood pressure (BP) can we “appropri- ately” hospitalise? Surely, the ones with a complicated hyper- tensive crisis, like the patient in the case report. What about the others? Is it enough to reduce the BP at presentation, re-edu- cate them on diet and treatment compliance, and then send them to the PCP with a recommendation to keep a diary of their BP for 10–14 days? Maybe diagnosing secondary hyper- tension is not the responsibility of the EP, especially duri

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