Pediatric Nephrology

, 24:1101 | Cite as

Severe hypertension in children and adolescents: pathophysiology and treatment

  • Joseph T. FlynnEmail author
  • Kjell Tullus


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.


Children 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.


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Copyright information

© IPNA 2008

Authors and Affiliations

  1. 1.Pediatric Hypertension Program, Department of PediatricsUniversity of Washington School of MedicineSeattleUSA
  2. 2.Division of Nephrology, A-7931Children’s Hospital & Regional Medical CenterSeattleUSA
  3. 3.Great Ormond Street Hospital for ChildrenLondonUK

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