Advances in the pathogenesis and management of hypertensive crisis

Abstract

Current knowledge of hypertensive crisis emphasizes the need for additional animal and translational studies with the goal of identifying the underlying molecular pathogenesis and developing new therapies to optimize future treatment of hypertensive emergencies.

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.…”

Severe hypertension in children and adolescents: pathophysiology and treatment

“…This transcription factor promotes the production of a large number of proinflammatory molecules, including proinflammatory cytokines such as several interleukins and tumor necrosis factor-α, chemokines such as MCP1, and vascular adhesion molecules. These all act in concert promoting inflammation of the blood vessel wall [23]. Double transgenic rats with both the renin and angiotensin genes have increased activation of NF-κB and marked renal and cardiac end-organ damage.…”

The management of hypertensive emergencies in children after stem cell transplantation

“…After continuous infusion of fenoldopam for greater than 48 h a tolerance can occur, which may lead to a reduced effectiveness [14]. Compared to the potency in adults fenoldopam showed a relatively poor efficacy in children [17].…”

“…In children, hypertensive emergencies present most commonly with signs and symptoms of hypertensive encephalopathy [14]. It can also result in cerebral infarction, acute myocardial infarction, acute left ventricular failure with pulmonary edema, unstable angina pectoris, dissecting aortic aneurysm, eclampsia [15] or hemorrhage in children.…”