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The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.

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Background: Hypertensive emergency (HTNE) is a subtype of hypertensive crisis. In contrast to hypertensive urgency (HTNU), which is a severely elevated BP without acute target organ damage (TOD), HTNE presents with the equally high BP in the presence of potentially life-threatening acute TOD such as myocardial infarction, stroke, pulmonary edema and acute kidney injury. Knowledge on risk factors of HTNE may be used in clinical decision-making to differentiate between HTNE and HTNU in patients presenting with markedly high BP. Method: A search of 4 databases (MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL), 7 grey literature sites and relevant organizational websites revealed 11,387 titles. After duplicates were removed, 9,183 studies were screened by the title and abstract for eligibility. Forty full-text articles were retrieved, and each was assessed for eligibility. Fourteen full-text studies that included 10,376 participants were critically appraised and included in this review. The extracted data were pooled to meta-analysis, where HTNU patients (BP ≥180/110 mmHg without acute TOD) were compared to HTNE patients (BP ≥180/110 mmHg with acute TOD) based on several modifiable and non-modifiable risk factors. Results: Patients with HTNE had higher mean systolic (MD 2.413, 95% CI 0.477,4.350) and diastolic BP (MD 2.043, 95% CI 0.624,3.461) compared to patients with HTNU. HTNE were more common in men (OR 1.390, 95% CI 1.207,1.601), older patients (mean diff 5.282, 95% CI 3.229, 7.335). Diabetes (OR 1.723, 95% CI 1.485, 2.000), hyperlipidemia (OR 2.028, 95% CI 1.642, 2.505), and chronic kidney disease (OR 2.448, 95% CI 1.169, 5.124) increased the risk of HTNE. Non-adherence to antihypertensives (OR 0.939, 95% CI 0.647,1.363) and HTN diagnosis unawareness (OR 0.807, 95% CI 0.564, 1.154) did not change the odds of HTNE. Conclusion: Systolic and diastolic BP are marginally higher in patients with HTNE compared to patients with HTNU. Since these differences are small and not clinically significant, clinicians should rely on other symptoms and signs to differentiate between HTNU and HTNE. Measures to prevent and treat cardiometabolic comorbidities should be implemented in order to mitigate the risk of HTNE.

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Title: 2-Year Morbidity and Mortality due to Hypertensive Crisis in a Predominantly African American Population Hypertensive crisis (HTNC) is a complication of Hypertension with a prevalence of 1-2%. HTNC is defined by a sudden and unpredictable increase in systolic blood pressure of ≥180 mmHg or diastolic blood pressure of ≥120 mmHg. HTNC may present as hypertensive urgency (HTNU) if asymptomatic, or hypertensive emergency (HTNE) if there are signs of end organ damage (EOD) eg: stroke (CVA), congestive heart failure (CHF), acute kidney injury (AKI), acute myocardial infarction (AMI) and death. A 2y retrospective cohort study of 1100 participants: 550 cases and 550 hypertensive controls BP >140/90) but < 200/120, matched for race, sex, and age, was conducted to determine the incidence of EOD, and the 2year mortality. The population was: Blacks 481/550 (87.4%), White 18/550 (3.3%), Asian 2/550 (0.4%) and other 49 /550 (8.9%). The mean SBP for cases was SBP 209.7 (SD=23.1), controls 147.8(SD=22.8) p=0.239; DBP cases 115.5 (SD=22.4), controls 84.2 (SD=14.1) p<.001. The incidence of new EOD for CHF: HTNE=39/440 (9.8%), HTNU=8/150 (5.3%), controls=6/550 (1.1%), p<.001; AKI HTNE=27/400 (6.8%), HTNU=5/150 (6.7 %), controls=17/550 (3.1%) p<0.001; AMI HTNE=6.5% and HTNU=2.7% controls=6/550 (1.1%) p<.001. There was no significant difference in the incidence of hemorrhagic and ischemic CVA, but the trend was higher in HTNE and HTNC for ischemic CVA: HTNE=4/400 (1%), HTNU=1/150 (0.7%), controls=(0.2%) p=.234. The 2y mortality for HTNE=82/400 (20.5%), HTNU=16/150 (10.6%), controls= 36/550 (6.5 %). The odds of dying was 3.5 times greater in the HTNU (OR 3.5, 95% CI 1.78-6.98), p<.001) and 4.3 times in the HTNE population (OR 4.3, 95% CI 2.65-7.01), p<.001). The study reveals a high morbidity and mortality associated with hypertensive crisis, with 1/5 of the population of HTNE dying in two years, mostly from related cardiovascular disease and renal failure.