First-attack pediatric hypertensive crisis presenting to the pediatric emergency department

Abstract

BackgroundHypertensive crisis in children is a relatively rare condition presenting with elevated blood pressure (BP) and related symptoms, and it is potentially life-threatening. The aim of this study was to survey children with first attacks of hypertensive crisis arriving at the emergency department (ED), and to determine the related parameters that predicted the severity of hypertensive crisis in children by age group.MethodsThis was a retrospective study conducted from 2000 to 2007 in pediatric patients aged 18 years and younger with a diagnosis of hypertensive crisis at the ED. All patients were divided into four age groups (infants, preschool age, elementary school age, and adolescents), and two severity groups (hypertensive urgency and hypertensive emergency). BP levels, etiology, severity, and clinical manifestations were analyzed by age group and compared between the hypertensive emergency and hypertensive urgency groups.ResultsThe mean systolic/diastolic BP in the hypertensive crisis patients was 161/102 mmHg. The major causes of hypertensive crisis were essential hypertension, renal disorders and endocrine/metabolic disorders. Half of all patients had a single underlying cause, and 8 had a combination of underlying causes. Headache was the most common symptom (54.5%), followed by dizziness (45.5%), nausea/vomiting (36.4%) and chest pain (29.1%). A family history of hypertension was a significant predictive factor for the older patients with hypertensive crisis. Clinical manifestations and severity showed a positive correlation with age. In contrast to diastolic BP, systolic BP showed a significant trend in the older children.ConclusionsPrimary clinicians should pay attention to the pediatric patients who present with elevated blood pressure and related clinical hypertensive symptoms, especially headache, nausea/vomiting, and altered consciousness which may indicate that appropriate and immediate antihypertensive medications are necessary to prevent further damage.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

“…In a study of 55 children presenting to a pediatric ED in Taiwan with hypertensive crisis, 96% had SBP greater than that of stage 2 HTN, and 76% had DBP greater than that of stage 2 HTN. 531 The major clinical issue in such children is that this level of BP elevation may produce acute target organ effects, including encephalopathy, acute kidney injury, and congestive heart failure. Clinicians should be concerned about the development of these complications when a child's BP increases 30 mm Hg or more above the 95th percentile.…”

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…There is no experimental evidence upon which recommendations on the optimal rate of BP reduction in hypertensive emergencies could be based. From clinical experience, BP should be lowered by no more than 25% of the planned BP reduction over the first 6-8 hours, followed by a further gradual reduction over the next 24-48 hours (227,(241)(242)(243)(244). Faster normalisation of severe HTN must be strictly avoided as it can cause more harm than severe HTN itself.…”

Area epidemiological research on hypertension risk factors of Keriyans in the Taklimakan Desert

“…4 Experimental animal studies also support the notion that high sodium intake can accelerate the development of hypertension and vascular damage. 5,6 Secondly, the drinking water of the Keriyans is from the sap seepage, which contains high levels of magnesium (119.23 mg/l) when compared with the standard threshold (20−30 mg/l), while the calcium content is relatively lower than the standard baseline (40−80 mg/l).…”