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• W2072396360 abstract "During the past year, the American College of Chest Physicians established a Consensus Panel on Hypertensive Emergencies in order to provide a self-assessment test for our members. Included among the members of this panel were the following: Doctors Haralambos Gavras, Boston University; Venkata Ram, University of Texas Southwestern Medical School; Sheldon Sheps, Mayo Clinic; Donald Vidt, Cleveland Clinic; and myself who also served as panel chairman. Our panel framed over 150 questions, discussed and corrected each of these; we excluded those that were ambiguous, and then circulated the remaining 105 questions as a self-assessment test among the members of the College. Of those physicians answering the questionnaire—and 497 physicians took the time to respond—65 percent had been in medical practice for six years or longer; and 60 percent were pulmonologists who were in full-time medical practice who indicated that a major portion of their practice time was spent in an intensive medical care setting in hospitals with fewer than 500 beds. Thus, it seems clear that the typical respondent was a pulmonary-intensive-care-oriented physician who was in active full-time community practice in a smaller to medium-sized hospital. In other words, the physician was not a high-tech super-specialist whose practice was in a large, academic, tertiary care referral center. From the responses to these questions, several observations may be drawn from the type of physician member of our College responding to the questionnaire. Most were relatively familiar with current concepts about clinical pharmacology, particularly as related to those antihypertensive agents useful in the treatment of hypertensive emergencies. Most of the physicians were aware of the variety of problems that may be termed hypertensive emergencies. However, it was also apparent that the respondents had some difficulty in recognizing some of the clinical signs and symptoms of these emergencies. And, among those hypertensive emergencies that require a clearer understanding by the average respondent were accelerated and malignant hypertension, acute dissection of an aortic aneurysm, and hypertensive encephalopathy. From a personal viewpoint, I continually am concerned with the frequent question raised today by physicians at meetings concerning the approach to “the patient with a hypertensive emergency.” Clearly, one concept that should be apparent from the nature of the varied questions and answers that were the subjects of our questionnaire is that there is no one, single, hypertensive emergency; nor is there a single, generic, specific approach to the treatment of a patient with a hypertensive emergency. On the contrary, there is a multiplicity of hypertensive problems that constitute an emergent hypertensive situation; and there is a broad spectrum of pharmacologic agents that may be selected for more specific treatment of certain hypertensive emergencies. Indeed, some agents that are useful for one hypertensive emergency may actually be contraindicated for another clinical situation. Our review of the responses to the questionnaire indicates some unfamiliarity with the clinical indications for selected parenteral antihypertensive agents useful for patients with hypertensive encephalopathy, dissecting aortic aneurysm, or postoperative repair of the aorta or large arteries. Similarly, there was an unfamiliarity with the various formulations of antihypertensive agents available for parenteral use and how best to administer them. For example, there seems to be some difficulty in selecting and administering continuous intravenous infusions of selected agents in very specific hypertensive emergencies. Thus, many college members were unfamiliar with the potential risks of administering intravenous diazoxide to patients with dissecting aortic aneurysm (or with acute pulmonary edema or acute myocardial infarction). In summary, then, there is a broad interest of College members to participate in self-test programs, and more specifically, dealing with relatively common emergent clinical situations. Those who responded probably reflect the mainstream of enlightened and well-trained practitioners in community hospitals; and they seem to be pulmonologists who have responsibility for management of patients in an intensive care setting. Most of these physicians have a good fund of knowledge concerning the practical clinical pharmacology of the variety of parenteral agents useful for hypertensive emergencies including their adverse and side effects. However, it appears that there may be some difficulty in translating this store of information into specific clinical circumstances requiring a more sophisticated selection of these agents for specific hypertensive emergencies. These generalized concepts suggest the value of providing reviews and discussions, perhaps in our College journal, Chest, that will enlighten the practitioner on this and related subjects. Finally, I want to take this opportunity to thank the members of the panel for their important contribution to our College's educational effort. And, on behalf of the entire panel, I wish to express our appreciation to: Jim Breeling, Director of Education; to Al Soffer, Executive Director; and DuPont Pharmaceuticals, Inc., for making this opportunity available to the membership through an educational grant-in-aid to the College. And, certainly, we thank all of you who volunteered to participate in this learning experience. We all derived much from this undertaking; hopefully, we shall continue on with the lessons that we have learned." @default.
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• W2072396360 date "1990-10-01" @default.
• W2072396360 modified "2023-09-27" @default.
• W2072396360 title "American College of Chest Physicians' Consensus Panel on Hypertensive Emergencies" @default.
• W2072396360 doi "https://doi.org/10.1378/chest.98.4.785" @default.
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