Intravenous Hydralazine in Hospitalized Children and Adolescents with Hypertension

Flynn, Joseph T.; Bradford, Miranda C.; Harvey, Eric

doi:10.1016/j.jpeds.2015.07.070

Cited by 16 publications

(6 citation statements)

References 7 publications

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“…It is unclear if these findings in adults can be generalized to children, as most children who develop hypertension in the hospital have no prior history of hypertension, 18 although excess MAP reduction has been reported in 31% of children treated with intravenous hydralazine. 35 In our study, the association between hypertension and AKI was attenuated by adjustment for BPV, suggesting that BPV may explain some of the association between hypertension and AKI. Our study was not designed to evaluate the effect of antihypertensive medication on BPV or AKI in children with hypertension.…”

Section: Discussionmentioning

confidence: 47%

Hypertension, Blood Pressure Variability, and Acute Kidney Injury in Hospitalized Children

Nugent

Ghazi

Yamamoto

et al. 2023

JAHA

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Background Although hypertensive blood pressure measurements are common in hospitalized children, the degree of inpatient hypertension and blood pressure variability (BPV) associated with end organ complications like acute kidney injury (AKI) is unknown. Methods and Results All analyses are based on a retrospective cohort of children aged 1 to 17 years with ≥2 creatinine measurements during admission from 2014 to 2018. We used time‐updated Cox models to evaluate the association between BPV and hypertension with AKI. Time‐varying BPV and hypertension were based on blood pressure in the preceding 72 hours. For the analysis of hypertension and AKI, we excluded patients on vasopressors to ensure comparison between hypertensive and normotensive patients. During 5425 pediatric encounters, 258 430 blood pressure measurements were recorded (median [interquartile range] 22 [11–47] readings per encounter). Among all measurements, 32.7% were ≥95th percentile and 18.9% were ≥99th percentile for age, sex, and height. AKI occurred in 389 (7.2%) encounters. We observed a U‐shaped relationship between mean blood pressure and incident AKI. BPV was associated with AKI, with the largest effect sizes in the systolic and mean arterial pressure variability measures. Multiple hypertension thresholds were associated with AKI after controlling for confounders. In an additional multivariable model adjusted for BPV, the association between hypertension and AKI was attenuated but remained significant for hypertension defined as three stage 2 measurements in 1 day (hazard ratio, 1.43 [95% CI, 1.01–2.01]). Conclusions Hypertension and BPV are associated with AKI in hospitalized children. Future studies are needed to determine how pharmacologic and nonpharmacologic interventions modify AKI risk in pediatric inpatients with hypertension.

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Section: Discussionmentioning

confidence: 47%

Hypertension, Blood Pressure Variability, and Acute Kidney Injury in Hospitalized Children

Nugent

Ghazi

Yamamoto

et al. 2023

JAHA

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“…The authors concluded that IV hydralazine was effective in the majority of those studied, and yet a substantial proportion of the subjects experienced potentially excessive BP reduction. 6 When considering treating elevated BP in a child or adolescent, one must always consider the context. Some key questions include: What is the age of the patient?…”

Section: Editorialsmentioning

confidence: 99%

“…4,5 In this issue of The Journal, Lessard et al used a multipollutant metric to examine the association between neighborhood level (ie, zip code) factors and hospitalizations for ambulatory care sensitive conditions (ACSCs), also termed preventable morbidities, in children living in the San Joaquin Valley of California, which experiences substantial environmental health disparities across zip codes. 6 ACSCs were defined as those health conditions where "treatment can help reduce the likelihood of hospitalizations through prevention and/ or management of the health condition." 6 Within this study, ACSCs consisted of asthma, pneumonia, and conditions for which immunizations are available.…”

Section: Editorialsmentioning

confidence: 99%

“…6 ACSCs were defined as those health conditions where "treatment can help reduce the likelihood of hospitalizations through prevention and/ or management of the health condition." 6 Within this study, ACSCs consisted of asthma, pneumonia, and conditions for which immunizations are available. Various indicators were used to represent neighborhood-level factors, including a pollution burden score based on 11 environmental indicators spanning multiple media including air and water 7 ; the Simpson Index of Diversity as a measure of racial/ethnic diversity; census data to ascertain poverty; and an estimate of primary care shortage (PCS) area.…”

Section: Editorialsmentioning

confidence: 99%

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Helping Hospitalized Patients with Hypertension: The Case for Hydralazine

Batisky

2016

The Journal of Pediatrics

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“…To address HTN among hospitalized children, “as‐needed” (PRN) antihypertensives are commonplace in inpatient care 9,10‐15 . However, recognition of abnormal BP in hospitalized children can be hindered by the need to consult age, sex, and height‐based BP percentiles for children <13 years of age; distractions and heavy clinical demands; the asymptomatic nature of hypertensive urgency; and non‐specific symptoms of hypertensive emergency in younger, especially non‐verbal, children.…”

Section: Introductionmentioning

confidence: 99%

Identification of hypertension in hospitalized children prescribed as‐needed antihypertensive medication

Kocher¹,

Tumin

Lehmann

et al. 2020

J of Clinical Hypertension

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Imperfect measurement conditions, transient blood pressure (BP) elevation due to pain or anxiety, and heavy clinical demands complicate hypertension (HTN) diagnosis in hospitalized children, and may prevent recognition of hypertensive episodes for children prescribed as‐needed (PRN) antihypertensive medication. The authors sought to describe the incidence and predictors of missed BP elevation among hospitalized children prescribed PRN antihypertensive medication at our hospital. BP data were retrospectively audited for children age 2‐18 admitted in 2018 to the general ward, and prescribed PRN oral nifedipine, intravenous [IV] or oral hydralazine, or IV labetalol. Appropriate recognition of BP elevation (exceeding the parameters in the medication order) was defined as administering medication within the ordered dosing interval, administering the medication earlier than planned, or physician documentation of why HTN treatment was withheld. Mixed‐effects logistic regression was used to identify factors associated with recognition of BP elevation. Fifty‐six hospitalizations including 616 BP measurements were analyzed. BP elevation was appropriately recognized in 230 (37%) instances, in most of which (n = 190) the antihypertensive medication was given after excessive BP was noted. On multivariable analysis, higher systolic BP and BP elevation occurring at night were associated with increased likelihood of appropriate recognition. BP elevations are frequently missed in hospitalized children prescribed PRN antihypertensive medication. Particularly, there was low recognition of diastolic BP elevation and of systolic BP elevation close to but still exceeding the ordered threshold. Further staff education may be needed to raise awareness of lower BP thresholds for HTN in younger and smaller children.

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Intravenous Hydralazine in Hospitalized Children and Adolescents with Hypertension

Cited by 16 publications

References 7 publications

Hypertension, Blood Pressure Variability, and Acute Kidney Injury in Hospitalized Children

Hypertension, Blood Pressure Variability, and Acute Kidney Injury in Hospitalized Children

Helping Hospitalized Patients with Hypertension: The Case for Hydralazine

Identification of hypertension in hospitalized children prescribed as‐needed antihypertensive medication

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