The efficacy and safety of intravenous hydralazine for the treatment of hypertension in the hospitalized child

Ostrye, Julie; Hailpern, Susan M.; Jones, Jenna; Egan, Brent M.; Chessman, Katherine; Shatat, Ibrahim F.

doi:10.1007/s00467-014-2772-0

Cited by 15 publications

(5 citation statements)

References 13 publications

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“…An average reduction in MAP of 19% was observed and a clinical response, defined as 10%–25% reduction in MAP, was demonstrated in 47% of patients. Similar to the aforementioned results by Ostrye et al, 33 a substantial number of patients (31%) demonstrated a potentially excessive BP drop, defined as >25% MAP reduction. 34 …”

Section: Medicationssupporting

confidence: 85%

“…That being said, results from two recent single-center retrospective studies evaluating the efficacy and safety of IV hydralazine in hospitalized children are now available. In 110 hospitalized children, Ostrye et al 33 reported a median reduction in systolic and diastolic BP of 8.5% and 11.5%, respectively. Of some concern, 21% of patients studied achieved a BP reduction exceeding 25% and an increase in BP was observed in 30% of the patients.…”

Section: Medicationsmentioning

confidence: 99%

“…A low rate of adverse effects (9%) was observed. 33 Recent data were additionally published in abstract form by Flynn et al, 34 who analyzed 141 first doses of hydralazine in hospitalized children. An average reduction in MAP of 19% was observed and a clinical response, defined as 10%–25% reduction in MAP, was demonstrated in 47% of patients.…”

Section: Medicationsmentioning

confidence: 99%

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Evaluation and treatment of hypertensive crises in children

Stein

Ferguson

2016

IBPC

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Hypertensive crises in children are medical emergencies that must be identified, evaluated, and treated promptly and appropriately to prevent end-organ injury and even death. Treatment in the acute setting typically includes continuous intravenous antihypertensive medications with monitoring in the intensive care unit setting. Medications commonly used to treat severe hypertension have been poorly studied in children. Dosing guidelines are available, although few pediatric-specific trials have been conducted to facilitate evidence-based therapy. Regardless of what medication is used, blood pressure should be lowered gradually to allow for accommodation of autoregulatory mechanisms and to prevent cerebral ischemia. Determining the underlying cause of the blood pressure elevation may be helpful in guiding therapy.

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Section: Medicationssupporting

confidence: 85%

Section: Medicationsmentioning

confidence: 99%

Section: Medicationsmentioning

confidence: 99%

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Evaluation and treatment of hypertensive crises in children

Stein

Ferguson

2016

IBPC

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“…Use of intravenous hydralazine in children in with acute HTN has been found safe and effective; however, the change in BP has been variable. In addition, primary adverse effects reported include rebound tachycardia, edema, and excessive BP reduction [134]. In addition, although the risk is higher in adults, hydralazine has the potential of inducing or exacerbating systemic lupus erythematosus in 5-10% of patients [135].…”

Section: Efficacy and Safetymentioning

confidence: 99%

Antihypertensive agents: a long way to safe drug prescribing in children

Siddiqi

Shatat

2019

Pediatr Nephrol

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Recently updated clinical guidelines have highlighted the gaps in our understanding and management of pediatric hypertension. With increased recognition and diagnosis of pediatric hypertension, the use of antihypertensive agents is also likely to increase. Drug selection to treat hypertension in the pediatric patient population remains challenging. This is primarily due to a lack of large, well-designed pediatric safety and efficacy trials, limited understanding of pharmacokinetics in children, and unknown risk of prolonged exposure to antihypertensive therapies. With newer legislation providing financial incentives for conducting clinical trials in children, along with publication of pediatric-focused guidelines, literature available for antihypertensive agents in pediatrics has increased over the last 20 years. The objective of this article is to review the literature for safety and efficacy of commonly prescribed antihypertensive agents in pediatrics. Thus far, the most data to support use in children was found for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB). Several gaps were noted in the literature, particularly for beta blockers, vasodilators, and the long-term safety profile of antihypertensive agents in children. Further clinical trials are needed to guide safe and effective prescribing in the pediatric population.

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“…To address HTN among hospitalized children, “as‐needed” (PRN) antihypertensives are commonplace in inpatient care 9,10‐15 . However, recognition of abnormal BP in hospitalized children can be hindered by the need to consult age, sex, and height‐based BP percentiles for children <13 years of age; distractions and heavy clinical demands; the asymptomatic nature of hypertensive urgency; and non‐specific symptoms of hypertensive emergency in younger, especially non‐verbal, children.…”

Section: Introductionmentioning

confidence: 99%

Identification of hypertension in hospitalized children prescribed as‐needed antihypertensive medication

Kocher¹,

Tumin

Lehmann

et al. 2020

J of Clinical Hypertension

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Imperfect measurement conditions, transient blood pressure (BP) elevation due to pain or anxiety, and heavy clinical demands complicate hypertension (HTN) diagnosis in hospitalized children, and may prevent recognition of hypertensive episodes for children prescribed as‐needed (PRN) antihypertensive medication. The authors sought to describe the incidence and predictors of missed BP elevation among hospitalized children prescribed PRN antihypertensive medication at our hospital. BP data were retrospectively audited for children age 2‐18 admitted in 2018 to the general ward, and prescribed PRN oral nifedipine, intravenous [IV] or oral hydralazine, or IV labetalol. Appropriate recognition of BP elevation (exceeding the parameters in the medication order) was defined as administering medication within the ordered dosing interval, administering the medication earlier than planned, or physician documentation of why HTN treatment was withheld. Mixed‐effects logistic regression was used to identify factors associated with recognition of BP elevation. Fifty‐six hospitalizations including 616 BP measurements were analyzed. BP elevation was appropriately recognized in 230 (37%) instances, in most of which (n = 190) the antihypertensive medication was given after excessive BP was noted. On multivariable analysis, higher systolic BP and BP elevation occurring at night were associated with increased likelihood of appropriate recognition. BP elevations are frequently missed in hospitalized children prescribed PRN antihypertensive medication. Particularly, there was low recognition of diastolic BP elevation and of systolic BP elevation close to but still exceeding the ordered threshold. Further staff education may be needed to raise awareness of lower BP thresholds for HTN in younger and smaller children.

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The efficacy and safety of intravenous hydralazine for the treatment of hypertension in the hospitalized child

Cited by 15 publications

References 13 publications

Evaluation and treatment of hypertensive crises in children

Evaluation and treatment of hypertensive crises in children

Antihypertensive agents: a long way to safe drug prescribing in children

Identification of hypertension in hospitalized children prescribed as‐needed antihypertensive medication

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