Emergency Management of Hypertension in Children

Abstract

Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information.

Hypertension and Hypertensive Heart Disease in Children and Adolescents

“…White-coat hypertension is common because most children are uncomfortable at the physicians' office, fearing invasive examinations, vaccinations, blood draws, and other factors. Use of 24-hour BP monitoring should be considered first in most uncomplicated cases of pediatric stage I hypertension [18,50].…”

“…The chosen agent should be started at the lowest dose and titrated as tolerated on the basis of adverse effects and treatment response (Table 7) [39]. A stepped-care approach individualized to the patient has been recommended [50,58]. Patients who do not respond to their initial drug may be switched to another drug in that class or to a cardiovascular risk associated with multiple risk factors.…”

“…Accurate assessment of BP in every patient presenting with a seizure is essential, particularly when no seizure disorder has been established in that patient [50,67].…”

“…• Nicardipine, 1-3 µg/kg/min IV infusion • Sodium nitroprusside, 0.53-10 µg/kg/min IV infusion to start Sublingual nifedipine is no longer recommended for the treatment of acute hypertension, because of reports of death from hypotension in the adult population [50,67].…”

The obese child in the Intensive Care Unit. Update

“…[71][72][73][74] Obese patients have endothelial and vascular smooth muscle dysfunction, 73 as well as a reduced parasympathetic nervous activity. 75,76 Arterial hypertension has been associated with a larger left ventricular mass in obese children. 74 Severe uncontrolled hypertension may lead to early organ damage.…”