Clinical Characteristics of Hospitalized Pediatric Patients With Hypertensive Crisis—A Retrospective, Single-Center Study in China

Abstract

BackgroundA hypertensive crisis is a medical emergency that causes acute damage to multiple organs. However, the etiology, clinical features, and prognosis of hypertensive crisis in Chinese children remain relatively unknown. The purpose of this study was to analyze the clinical characteristics of pediatric hypertensive crisis patients from a single center in China.MethodsWe analyzed data from 70 children with hypertensive crisis between January, 2000, and January, 2022. The patients were divided into two groups: those diagnosed with a hypertensive emergency (n = 46) and those diagnosed with hypertensive urgency (n = 24). Baseline etiologies and risk factors were compared between the two groups. The following data were collected and analyzed: age, sex, weight, height, family history of hypertension, blood pressure, clinical manifestations of hypertensive crisis, underlying causes, biochemical indicators, and antihypertensive drugs.ResultsThe major symptoms of hypertensive crisis were headache (n = 31, 44.29%), followed by visual symptoms (n = 15, 21.43%), and dizziness (n = 13, 18.57%). Further analysis showed that the incidence of convulsions was significantly higher in patients with hypertensive emergency than those with hypertensive urgency (χ2 = 5.38, p = 0.02). The leading underlying causes were renal disease (n = 34, 48.57%), followed by vascular disease (n = 11, 15.71%), essential hypertension (n = 9, 12.86%), oncological disease (n = 9, 12.86%), central nervous system disease (n = 3, 4.29%), endocrine and metabolic diseases (n = 2, 2.86%), and other (one case with lead poisoning, one case with histiocytosis). End-organ damage occurred in 46 patients with hypertensive crisis, including retinal damage (n = 20, 43.48%), brain damage (n = 19, 41.30%), heart damage (n = 15, 32.61%), and renal damage (n = 3, 6.52%). Hypertensive crisis was most common among children aged 7–12 years. Among children aged 13–18 years, hypertensive urgency was more common than hypertensive emergency. The incidence of dyslipidemia, elevated serum creatinine, and elevated uric acid did not differ significantly between the two groups. Most patients with hypertensive crisis need combined antihypertensive therapy (n = 60, 85.71%). There were no cases of mortality.ConclusionsHypertensive crisis is caused by secondary diseases, especially renal disease and vascular disease, in the majority of pediatric patients. Combination therapy with antihypertensive agents and treatment of secondary etiology results in a good prognosis.

Effect of Sleep Duration on Blood Pressure in Patients with SARS-CoV-2 Infection and Hypertensive Urgencies in Shanghai Fangcang Shelter Hospital

“… 29 Hypertensive emergency refers to a severe increase in blood pressure within a short period of time [usually systolic blood pressure (SBP)> 180 mmHg and/or diastolic blood pressure (DBP)> 110 mmHg accompanied by progressive target organ damage. 29 , 30 Hypertension subemergency refers to a significant increase in blood pressure without target organ damage and usually does not require hospitalization. However, oral administration of antihypertensive drugs should be performed immediately to evaluate and monitor possible target organ damage, such as to the heart, brain, and kidney, and also to determine the possible cause of blood pressure increase.…”

“…Self-regulation practices include maintaining a quiet environment, adjusting mood and a reasonable diet, and adjusting work intensity and time. 30–32 However, many infection patients coexist in the Fangcang shelter hospital, with noisy voices and bright lights, and it is difficult to ensure privacy. Therefore, the patients are more likely to have sleep disorders.…”

Management of acute severe hypertension in youth: from the philosophical to the practical

“…Acute severe hypertension has historically been classified into either hypertensive emergency or urgency, based on the presence of acutely new or worsening symptoms or signs of life-threatening target organ injury, most commonly involving the brain, eyes, heart and kidneys [1,5]. Common symptoms include headache, dizziness, vomiting, visual disturbances and altered consciousness and/or cognition, and neurologic symptoms generally are most common [6 ▪ ,7]. Patients may have systolic or diastolic heart dysfunction, congestive heart failure, reversible posterior leukoencephalopathy syndrome, cortical blindness or acute kidney injury.…”

“…However, among youth with chronic hypertension or other high-risk conditions, acute severe hypertension is much more common, though the specific incidence and prevalence remain poorly defined. In a retrospective study of 462 youth hospitalized with hypertension, 70 met criteria for acute severe hypertension as defined by a blood pressure at or above the 99th percentile for age, sex, and height plus 5 mmHg, with 34% having hypertensive urgency and 66% having hypertensive emergency [6 ▪ ]. Demographic data are limited, but most studies report that acute severe hypertension is more common in males (67–83%), school-aged children and adolescents (54–78%), and youth with obesity (5–29%) and secondary causes of hypertension, especially kidney disease (48.6%), vascular disease (15.7%) and primary hypertension (12.9%), with renal artery stenosis the most common cause due to kidney disease (44.1–48.6%) [6 ▪ ,8,9 ▪ ,10,11 ▪ ,12,13].…”