Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

Abstract

Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%–5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period.

Hypertensive Crisis: The Other Side of Polyarteritis Nodosa

“…Hypertensive emergency is defined as having an acute elevation in systolic or diastolic blood pressure that is associated with end-organ damage, such as heart, kidneys, and the central nervous system. Hypertensive urgency shares the same definition, though it occurs without end-organ damage and may simply manifest with a headache and/or vomiting [13].…”

Hypertensive Retinopathy as a Presenting Sign of Pheochromocytoma with Malignant Hypertension: A Child Case

“…Hypertension in pediatric population is estimated to have a world-wide prevalence of 2–5% [ 1 ], while hypertension crisis, such as malignant hypertension (MHT), is an extremely rare condition [ 1 , 2 ]. MHT in children older than 10 years is characterized by two major features: severe increase in systolic blood pressure (BP), diastolic BP or both (≥170 mm Hg systolic and ≥110 mm Hg diastolic) [ 3 ], and hypertensive retinopathy grades 3 or 4 according to the classification of Keith et al [ 4 ].…”

“…MHT in children older than 10 years is characterized by two major features: severe increase in systolic blood pressure (BP), diastolic BP or both (≥170 mm Hg systolic and ≥110 mm Hg diastolic) [ 3 ], and hypertensive retinopathy grades 3 or 4 according to the classification of Keith et al [ 4 ]. Renal vascular diseases and primary hypertension are recognized as the main causes of pediatric hypertension in children older than 10 years [ 2 , 5 – 7 ], while pheochromocytomas are extremely rare conditions [ 1 , 2 , 5 ].…”

Hypertension in children in emergency department

“…Factors such as volume overload or sympathetic stimulation by tumors, renin-angiotensin system, drugs, or other processes, may have a main role in the development of hypertension ( 2 , 5 ). Essential hypertension presented with unspecific sign and symptom consist of headache, chest pain, falling asleep, daytime tiredness, and abdominal pain, also oral contraceptives, steroids, and illicit drugs (e.g., cocaine, amphetamines) should be asked in >10 years old children ( 6 , 7 ). The physician must perform a brief but through history and physical examination for the patients with persistently high blood pressure at ED.…”

“…an appropriate history include frequency of urinary tract infections, dysuria, hematuria, frequency, unexplained fevers, edema, history of umbilical artery catheterization as neonate, history of head trauma, ingestion of illicit drugs, oral contraceptives, rapid withdrawal of hypertension drug agents, and history of flushing, sweating, fever, weight loss. In the physical examination should paying a particular attention to the cardiovascular system, neurological and renal system such as four-limb blood pressures, Heart rate, respiratory rate, heart sound, lung sound, oxygen saturation, funduscopic examination, neurologic examination, auscultation abdomen ( 4 , 5 , 7 ).…”