Severe hypertension in children and adolescents: pathophysiology and treatment
- 1.4k Downloads
Severe, symptomatic hypertension occurs uncommonly in children, usually only in those with underlying congenital or acquired renal disease. If such hypertension has been long-standing, then rapid blood pressure reduction may be risky due to altered cerebral hemodynamics. While many drugs are available for the treatment of severe hypertension in adults, few have been studied in children. Despite the lack of scientific studies, some agents, particularly continuous intravenous infusions of nicardipine and labetalol, are preferred in many centers. These agents generally provide the ability to control the magnitude and rapidity of blood pressure reduction and should—in conjunction with careful patient monitoring—allow the safe reduction of blood pressure and the avoidance of complications. This review provides a summary of the underlying causes and pathophysiology of acute severe hypertension in childhood as well as a detailed discussion of drug treatment and the optimal clinical approach to managing children and adolescents with acute severe hypertension.
KeywordsChildren Clonidine Esmolol Hydralazine Hypertension Kidney disease Labetalol Nicardipine
Statement of Disclosure
Joseph Flynn is a consultant to Boehringer Ingelheim Pharmaceuticals, Novartis Pharmaceuticals, and Pfizer, Inc. Kjell Tullus has no consulting relationships to disclose.
- 1.National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2005) The Fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. National Institute of Health publication 05:5267. Bethesda, MD, National Heart, Lung, and Blood InstituteGoogle Scholar
- 4.Flynn JT (2005) Hypertension in childhood and adolescence. In: Kaplan NM (ed) Kaplan’s clinical hypertension, 9th edn. Lippincott-Williams and Wilkins, Philadelphia, pp 465–488Google Scholar
- 12.Flynn JT, Woroniecki RP (2003) Pathophysiology of hypertension. In: Avner E, Harmon W, Niaudet P (eds) Pediatric nephrology, 5th edn. Lippincott Williams and Wilkins, Philadelphia, pp 1153–1178Google Scholar
- 18.Rauth W, Hund E, Sohl G, Rascher W, Mehls O, Scharer K (1983) Vasoactive hormones in children with chronic renal failure. Kidney Int Suppl 15:S27–S33Google Scholar
- 26.Seeman T (2007) Hypertension after renal transplantation. Pediatr Nephrol doi: 10.1007/s00467-007-0627-7
- 28.U.S. Food and Drug Administration. Summaries of medical and clinical pharmacology reviews of pediatric studies. Available at: http://www.fda.gov/cder/pediatric/Summaryreview.htm. Accessed 3 June 2008
- 35.Public law 107–109. Best Pharmaceuticals for Children Act. Enacted January 4, 2002. Available at: http://www.fda.gov/opacom/laws/pharmkids/contents.html. Accessed 3 June 2008
- 36.Rocco TP, Fang JC (2006) Pharmacotherapy of congestive heart failure. In: Brunton LL, Lazo JS, Parker KL (eds) Goodman & Gilman’s the pharmacological basis of therapeutics, 11th edn. McGraw-Hill, New York, pp 869–898Google Scholar
- 41.Hoffman BB (2006) Therapy of hypertension. In: Brunton LL, Lazo JS, Parker KL (eds) Goodman & Gilman’s the pharmacological basis of therapeutics, 11th edn. McGraw-Hill, New York, pp 845–868Google Scholar