Hypertensive crisis in children: an experience in a single tertiary care center in Korea

Abstract

BackgroundHypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea.MethodsWe analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs.ResultsKidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration.ConclusionClose blood pressure monitoring and careful examinations should be mandatory in children with underlying disease, especially renal diseases and cancer. Furthermore, both nicardipine and labetalol may be effective antihypertensive drug in lowering high blood pressure in children with hypertensive crisis.

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

“…All patients presenting with hypertensive crisis do warrant a thorough evaluation to look for an underlying secondary cause for hypertension as directed by their clinical symptoms, presentation, and examination findings. A retrospective cohort study, looking at the etiology, treatment, and outcomes of the pediatric hypertensive crisis amongst pediatric patients presenting to Yonsei University Severance Hospital, South Korea, was performed by Lee et al 1 In this study, all 51 patients received treatment with either labetalol, hydralazine, nicardipine or nitroprusside. In contrast, only 34 (72.3%) of our patients received antihypertensive medications.…”

“…Most children who present with hypertensive crisis have secondary hypertension 1,2 and renal pathology is the most common etiology. 2 To date, there remains limited data and consensus for the optimal treatment of hypertension in children.…”

“…2 To date, there remains limited data and consensus for the optimal treatment of hypertension in children. 1,3 Various agents, both oral and intravenous have been used with good results with no major mortality and morbidity. 4,5 Our study aims to describe the epidemiology and management of children treated for hypertensive crisis in our institution.…”

Hypertensive Crisis in Pediatric Patients: An Overview

“…Of the known presentations of hypertensive emergencies, acute neurological signs are most common and are a result of disruption of the blood-brain barrier, insufficient oxygen delivery, and edema and microhemorrhages (42). These neurologic symptoms may be non-specific, with 55% of patients experiencing headaches, 46% with dizziness, and 36% with nausea/vomiting, as in hypertensive urgency, but can also present with further signs of neurologic damage, with 16% presenting with altered consciousness and 11-20% experiencing seizures (16,43). A severe neurological complication of hypertensive crisis in children is posterior reversible encephalopathy syndrome (PRES), which principally involves damage to the occipito-parietal white matter and may spread to the basal ganglia, cerebellum, and brainstem.…”

“…Furthermore, hypertensive emergencies can cause cardiovascular remodeling in the form of left ventricular hypertrophy (LVH), which can consequently lead to congestive heart failure (CHF), manifesting with signs and symptoms such as dyspnea, chest discomfort, and gallop rhythm on auscultation. Several studies have shown that 13-26% of patients with hypertensive emergency have LVH (18,43). Of note, several case reports have shown that hypertensive crisis in infants and neonates may paradoxically present with hypotension and cardiogenic shock (48,49).…”