Saturday, February 22, 2014

Severe hypertension: urgency or emergency?

Check the pulse.

Via Hospital Medicine Virtual Journal Club.

1 comment:

Vince DiGiulio said...

First off, I thought hypertensive "crisis" was a meaningless and dead term. "Urgency" seems to be equally useless in practice, though it has some meaning.

But getting into the meat of the matter, it would seem from the abstract that we could probably chalk up most of the difference between the pulse rates of the "urgent" and emergent cases to the inclusion of hypertensive LV failure in the emergent group. Of course these patients are going to be tachycardic; they're drowning in acute pulmonary edema and breathing 40/min. Sadly I'm paywalled out of the full-text (even with decent academic access) so I can't confirm my hunch by checking out the details, but it seems reasonable. If you dropped the biggest and most obvious patient group whose rales you can hear from the doorway, then I highly doubt the HR would offer any additional insight into the nature of these patients' hypertension.

Not that I really care because, again, what use is a study whose foundation rests on a poor understanding of the disease process of interest. It would be like performing an intervention study on Q-wave vs. non Q-wave MI's; who even thinks in those terms any more?

Part of me wonders if the authors have ever even seen a patient with acute hypertensive LV failure...