title: Heart rate differentiates urgency and emergency in hypertensive crisis.
abstract: OBJECTIVE
  To study the clinical significance of presenting blood pressure parameters and heart rate in patients with hypertensive crisis.
  
  
  METHODS
  In patients admitted with hypertensive crisis between January 2011 and May 2011, demography, mode of presentation, co-morbidities, blood pressure readings, and heart rate at presentation were documented. Further clustering of hypertensive crisis into emergency or urgency was based on the presence or absence of target organ involvement. The relationship between blood pressure parameters, heart rate, and other variables was analyzed.
  
  
  RESULTS
  189 patients in sinus rhythm were enrolled in this pilot study. The rate of hypertensive urgency was 56 %, whereas the rate of hypertensive emergency was 44 %, respectively. Subjects with hypertensive emergency had a higher mean heart rate (93 ± 22.7 bpm) than those with urgency (81 ± 11.5 bpm) (P = 0.015). Women had higher heart rates (92 ± 18.5 bpm) than men (86 ± 17.6 bpm) (P = 0.014). Heart rates below 100 bpm had a specificity of 94 %, classifying patients as hypertensive urgency. Tachycardia had a powerful statistical association with hypertensive left ventricular failure (P < 0.0001). Other hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, pulse pressure, and mean blood pressure relates neither to urgency nor to emergency. Diabetic patients with HBA1c levels of more than 53 mmol/mol had a heart rate of more than 100 bpm (P = 0.015) during hypertensive crisis.
  
  
  CONCLUSIONS
  Normal heart rate is characteristic of hypertensive urgency. Tachycardia in this setting is an ominous sign and denotes hypertensive complications in particular left ventricular failure. Among diabetics, elevated heart rate is associated with poor glycemic control.
authors.affiliation: Cardiology Unit, Internal Medicine Department, Salmaniya Medical Complex, PO Box 12, Manama, Kingdom of Bahrain. abdullarashed@yahoo.com
authors.forename: Rashed
authors.initials: R
authors.lastname: Al Bannay
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Aysha
authors.initials: A
authors.lastname: Husain
mesh_terms: D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D004630:Emergencies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012737:Sex Factors; D013610:Tachycardia / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D006442:Glycated Hemoglobin