National survey on excellence centers and reference centers for hypertension diagnosis and treatment: geographical distribution, medical facilities and diagnostic opportunities.

INTRODUCTION: Blood pressure (BP) control is poorly achieved in Western Countries, including Italy. Several interventions have been proposed at national and local level to improve BP control rate. AIM: This survey of the Italian Society of Hypertension (SIIA) is aimed at analysing the number and the distribution of reference centers and excellence centers for the diagnosis and treatment of arterial hypertension (hypertension centers) in Italy.
METHODS: In October 2011, a specifically designed survey questionnaire was developed by SIIA National Committee, both to evaluate geographical distribution of the reference hypertensive population and to assess general requirements (days of activity, number of active physicians, medical facilities, diagnostic opportunities, use of electronic support), deemed necessary to identify an outpatient clinic as hypertension center in Italy. This questionnaire was locally distributed by regional coordinators of the Society and all collected data were centrally analysed by two independent study coordinators.
RESULTS: From October 2011 to September 2012, 89 centers with clinical expertise in the diagnosis and treatment of hypertension provided data on their own activity. Among these, 45 (50.5 %) centers are located in the North, 20 (22.5 %) in the Center and 24 (27.0 %) in the South of Italy. Approximately 50 % of the hypertensive outpatients who are referred from general practitioners to hypertension centers are living in the province and about one third in the region. More than half of the centers is active for 3-5 days per week, and approximately 40 % of the centers have 3-5 active physicians. Beyond outpatient visits for hypertension, these centers are able to organize day hospital (25 %), day service (29 %), or hospital admission (29 %) for advanced diagnostic evaluation or therapeutic interventions. All centers collect data from clinic and 24-hour ambulatory BP measurements, and almost all (95 %) centers are able to perform a standard 12-lead electrocardiogram. In addition, the majority of the centers are able to perform advanced diagnostic examinations, including echocardiography (74 %) or carotid Doppler ultrasound (71 %) analysis. Finally, 78 % of the centers use an electronic case report form, specifically designed for the clinical management of hypertensive patients.
CONCLUSIONS: Although with some limitations related to the study methodology applied for data collection, the survey illustrates a quite unbalanced distribution of the hypertension centers, the majority of which are located in the North of Italy, with a medium-high standard of quality of care. This analysis may provide useful elements for a rational and effective use of existing resources, in order to improve BP control in our Country.