Adverse neurologic events associated with rebound hypertension after using short-acting nifedipine in childhood hypertension

Abstract

The temporal association of the neurologic events with the rebound increase in BP suggests a possible role for the SA-NIF, consistent with its pharmacokinetic profile. Although the adult literature has focused on the unpredictable decline in BP after SA-NIF treatment, these cases suggest that rapid increases in BP following the maximal SA-NIF effect may be associated with impaired cerebral autoregulation and encephalopathy in children. These cases underscore the need for frequent blood pressure determinations and therapy to prevent rebound hypertension.

Calcium channel blockers: pharmacology and place in therapy of pediatric hypertension

“…hypertensive children treated with sublingual nifedipine [138][139][140][141]. Several of these children developed transient neurologic deficits similar to those reported in adults [138,141]. We have seen several problems related to this effect of sublingual nifedipine in our own institution, including one case of severe hypotension in a liver transplant recipient that could potentially have led to hepatic artery thrombosis [142].…”

“…Given the recent developments in the United States with respect to pediatric drug trials spurred by the Food and Drug Modernization Act of 1997 [148], we are hopeful that welldesigned trials of CCBs in children will be conducted in order to answer the remaining questions regarding pediatric use of CCBs. hypertensive children treated with sublingual nifedipine [138][139][140][141]. Several of these children developed transient neurologic deficits similar to those reported in adults [138,141].…”

Ventricular arrhythmia following short-acting nifedipine administration

“…Adverse neurologic sequelae have also recently been reported in children treated with short-acting nifedipine [8,9]. Finally, it is instructive to note that even the early descriptions of short-acting nifedipine use in children reported that the magnitude and duration of blood pressure reduction following administration of this agent were unpredictable [1].…”

“…On the other hand, in adults, short-acting nifedipine is now considered contraindicated in the treatment of severe hypertension due to well-documented adverse effects, including cerebrovascular ischemia, stroke, arrhythmias, hypotension and death [2,3,4,5,6]. Recently, however, several reports have appeared documenting either excessive drops in blood pressure [7,8] or adverse events in children treated with short-acting nifedipine secondary to the abrupt decrease in blood pressure [8] or the associated rebound hypertension [9]. We now report the development of a ventricular arrhythmia in an adolescent following short-acting nifedipine administration.…”

The Assessment and Management of Hypertensive Emergencies and Urgencies in Children

“…Instead, case reports have been published detailing rebound hypertension causing adverse neurologic events associated with the use of shortacting nifedipine. 25 Nevertheless, many nephrologists continue to use nifedipine for the treatment of moderate to severe hypertension. Blaszak et al 26 published a retrospective study of 117 children treated with nifedipine, determining that the drug is safe and effective provided the initial dose is no greater than 0.25 mg/kg.…”