Epidemiology and Management of Children with Hypertensive Crisis: A Single-Center Experience

Abstract

Most children who present with hypertensive crisis have a secondary cause for hypertension. This study describes the epidemiology and management of children with hypertensive crisis. A retrospective cohort study was done in a tertiary pediatric hospital from 2009 to 2015. Thirty-seven patients were treated for hypertensive crisis. Twelve (32.4%) patients were treated for hypertensive emergency. The majority of our patients (33 [89.1%]) had a secondary cause of hypertension. The most common identifiable cause of hypertension was a renal pathology (18/37 [48.6%]). Oral nifedipine (23 [62.1%]) was the most frequently used antihypertensive, followed by intravenous labetalol (8 [21.6%]). There were no mortalities or morbidities. Hypertensive crisis in children is likely secondary in nature. Oral nifedipine and intravenous labetalol are both effective treatments.

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

“…Among secondary factors, approximately half of the cases are due to renal disease, including renal artery stenosis, which was found in 44.12% of the patients. This percentage is much higher than that reported in a study conducted in Singapore ( 25 ). In our study, the second leading cause of hypertensive crisis was vascular disease, accounting for approximately 15.71% of cases.…”

“…It is noteworthy that takayasu's arteritis is the predominant vascular disease, which has not been reported in other studies. In our study, approximately 52.63% of hypertensive crisis due to renal parenchymal disease were caused by end-stage renal disease, which is a higher percentage than that reported in studies from other countries ( 22 , 25 ). A possible reason may be related to the fact that our hospital is the Children's Kidney Disease Center in South China, so we receive a larger number of referrals involving pediatric kidney disease.…”

“…The most common tumor was pheochromocytoma, followed by blastoma. The proportion of hypertensive crisis due to oncological disease was lower than that in Korea ( 22 ), but similar to that in Singapore ( 25 ). Essential HTN was also observed to be a cause of hypertensive crisis in this study, and mainly contributed to hypertensive urgency in adolescents, which was consistent with previous study findings ( 21 ).…”

“…In a study from Korea, cancer was found to be the main cause of hypertensive crisis in children, both in hypertensive emergency and hypertensive urgency ( 22 ). Another study from Singapore found that chronic kidney disease and obesity were the leading causes of hypertensive emergency, while cancer and obstructive sleep apnea were the leading causes of hypertensive urgency ( 25 ). These are the main differences observed in the etiology of hypertensive crisis between previous studies and our study.…”

"Lupus Nephritis: Viewing Kidneys Through Retinal Periscope"

“…Secondary hypertension has more propensity of developing into hypertensive crisis. Since most of the cases are asymptomatic and the prognosis is better when the disease is diagnosed early, it is prudent that all children above the age of three years should undergo an annual BP measurement [3]. Secondary hypertension evaluation is guided by the etiology specific to that particular age group and sex, like-renal parenchymal disease, endocrine causes, coarctation of aorta and essential hypertension.…”