Hypertensive Encephalopathy

Abstract

ObjectiveHypertension is called the silent killer and vital organs such as the brain, eyes, kidneys and the heart are the targets. Seizure, central nervous system (CNS) hemorrhage, and cerebrovascular accident (CVA), blindness and heart attacks are the end points. The prevalence of hypertension in children is much less than adults, but evidence reveals that the source of hypertension in adulthood goes back to childhood. In 70-80% of cases hypertension is due to renal diseases. In children, hypertensive encephalopathy (HE) may be the first manifestation of renal diseases. Seizure is one of the most common manifestations of HE. In this article, definitions, etiology, pathophysiology and finally the acute and chronic managements of HE will be discussed. Keywords: Hypertension; Hypertensive encephalopathy; Children Introduction Hypertension (HTN) is the second most common cause of death after diabetes in adults worldwide. Some authors call it the silent killer and others believe that it is not so silent (1, 2). Between 1 and 5 percent of children and 15% of young adults suffer from hypertension while more than 60% of adults above the age of 65 years have hypertension. If the child's blood pressure (BP) is more than the 90 th percentile, the incidence of hypertension in adulthood rises 2-4 fold. Therefore, it is postulated that childhood diseases such as reflux nephropathy (RN) are the reason of hypertension in adulthood (3, 4). Based on the World Health Organization (WHO) reports, hypertension is the cause of 62% of cerebrovascular accidents (CVA) and 49% of ischemic heart diseases. For every 5 mmHg increase in diastolic BP, there is a 35% and 20% increase in the risk of CVA and coronary artery disease, respectively. In addition, hypertension is the cause of up to 50% of end stage renal diseases (ESRD) requiring dialysis and transplantation in adults. DefinitionsSince BP values differ with the child's age, sex, height, weight and environment, definitions are based on the percentile of related monograms (3-7). If the BP is between the 90th and 95th percentile, the child is pre-hypertensive. Blood pressures between 95th and 99th percentile +5 mmHg are stage 1 and more than 99th percentile +5 mmHg are stage 2 hypertension (8, 9).