Hypertensive crisis in children

Abstract

Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure. Precipitous drops in blood pressure can result in impairment of perfusion of vital organs. Medications commonly used to treat hypertensive crisis in children are nicardipine, labetalol and sodium nitroprusside. In this review, we discuss the pathophysiology, differential diagnosis and recent developments in management of hypertensive crisis in children.

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.…”

Reninoma: An Uncommon Cause of Renin-Mediated Hypertension

“…Severe hypertension (usually defined as blood pressure at least 20 mmHg above the 95% percentile for age, sex, and height) requires immediate medical attention with gradual reduction of blood pressure and thorough investigations for the secondary causes of hypertension (2). …”

Severe renal vascular hypertension caused by upper left branch renal artery stenosis complicated with multiple thrombosis and cardiac hypertrophy

“…Hypertensive crisis in children are usually secondary to underlying disease [1,3,6]. It is prone to considerable complications, even lethal outcome [1].…”