Advertisement

Pediatric Nephrology

, Volume 29, Issue 8, pp 1403–1409 | Cite as

The efficacy and safety of intravenous hydralazine for the treatment of hypertension in the hospitalized child

  • Julie Ostrye
  • Susan M. Hailpern
  • Jenna Jones
  • Brent Egan
  • Katherine Chessman
  • Ibrahim F. ShatatEmail author
Original Article

Abstract

Background

Intravenous (IV) hydralazine is frequently used for the treatment of elevated blood pressure (BP) in hospitalized children. Its safety and efficacy have not been examined.

Methods

This is a retrospective chart review of IV hydralazine use in hospitalized children (birth to 17 years) over a 3-year period. Demographic data and data on adverse effects (AE), BP, and heart rate (HR) prior to and after each first dose were collected.

Results

The patient cohort comprised 110 children admitted to the hospital during the study period, of whom 77 received the recommended dose. Mean age of the children was 8.5 ± 5.4 years; 33 % were male, and 32.5 % were white. Pre-dose systolic and diastolic BP indexes were 1.3 and 1.2, respectively. The median reduction in systolic and diastolic BP was 8.5 and 11.5 %, respectively. Sixteen (21 %) children achieved a 25 % reduction in systolic or diastolic BP, and BP increased in 30 % of patients; 10 % of children had a BP of <95th percentile for age, sex, and height after one dose. Seven (9 %) children had a documented AE. HR increased by a median of 3.5 %. In the multivariable models examining percentage change in systolic and diastolic BP, male gender was significantly associated with a change in systolic BP.

Conclusions

In hospitalized children, IV hydralazine was well tolerated, BP response was variable, and 21 % of the patients achieved a ≥25 % reduction of systolic or diastolic BP. Further studies are needed to compare the safety and efficacy of IV hydralazine to other short-acting antihypertensive agents.

Keywords

Elevated blood pressure Hydralazine Intravenous Hospitalized Pediatric Medication safety Drug therapy 

References

  1. 1.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576Google Scholar
  2. 2.
    Taketomo CK, Hodding JH, Kraus DM (2013) Pediatric & neonatal dosage handbook, vol 20th. American Pharmacists Association, LexicompGoogle Scholar
  3. 3.
    Hari P, Sinha A (2011) Hypertensive emergencies in children. Ind J Pediatr 78:569–575CrossRefGoogle Scholar
  4. 4.
    Flynn JT, Tullus K (2009) Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol 24:1101–1112PubMedCrossRefGoogle Scholar
  5. 5.
    Adelman RD, Coppo R, Dillon MJ (2000) The emergency management of severe hypertension. Pediatr Nephrol 14:422–427PubMedCrossRefGoogle Scholar
  6. 6.
    Campbell P, Baker WL, Bendel SD, White WB (2011) Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified. J Am Soc Hypertens 5:473–477PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC growth charts for the United States: methods and development. Vital and Health Statistics Series 11, Number 246. U.S. Center for Disease Control and Prevention, AtlantaGoogle Scholar
  8. 8.
    (1952) NEW approved drugs: hexamethonium bromide; hydralazine hydrochloride. Med Bull (Ann Arbor) 18:185–187Google Scholar
  9. 9.
    Cohn JN, McInnes GT, Shepherd AM (2011) Direct-acting vasodilators. J Clin Hypertens (Greenwich) 13:690–692CrossRefGoogle Scholar
  10. 10.
    Kline RL, McLennan GP (1991) Chronic hydralazine treatment alters the acute pressure-natriuresis curve in young spontaneously hypertensive rats. Can J Physiol Pharmacol 69:164–169PubMedCrossRefGoogle Scholar
  11. 11.
    Kandler MR, Mah GT, Tejani AM, Stabler SN, Salzwedel DM (2011) Hydralazine for essential hypertension. Cochrane Database Syst Rev 2011;(11):CD004934Google Scholar
  12. 12.
    Paterson-Brown S, Robson SC, Redfern N, Walkinshaw SA, de Swiet M (1994) Hydralazine boluses for the treatment of severe hypertension in pre-eclampsia. BJOG-Br J Obstet Gynaec 101:409–413CrossRefGoogle Scholar
  13. 13.
    Devlin JW, Dasta JF, Kleinschmidt K, Roberts RJ, Lapointe M, Varon J, Anderson FA, Wyman A, Granger CB (2010) Patterns of antihypertensive treatment in patients with acute severe hypertension from a nonneurologic cause: Studying the Treatment of Acute Hypertension (STAT) registry. Pharmacotherapy 30:1087–1096PubMedCrossRefGoogle Scholar
  14. 14.
    Varon J, Marik PE (2008) Perioperative hypertension management. Vasc Health Risk Manag 4:615–627PubMedCentralPubMedGoogle Scholar
  15. 15.
    Miyashita Y, Peterson D, Rees JM, Flynn JT (2010) Isradipine for treatment of acute hypertension in hospitalized children and adolescents. J Clin Hypertens (Greenwich) 12:850–855CrossRefGoogle Scholar
  16. 16.
    Thomas CA, Moffett BS, Wagner JL, Mott AR, Feig DI (2011) Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children. Pediatr Crit Care Med 12:28–32PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2014

Authors and Affiliations

  • Julie Ostrye
    • 1
  • Susan M. Hailpern
    • 3
  • Jenna Jones
    • 4
  • Brent Egan
    • 5
  • Katherine Chessman
    • 2
  • Ibrahim F. Shatat
    • 6
    Email author
  1. 1.Cincinnati Children’s Hospital Medical CenterDepartment of PharmacyCincinnatiUSA
  2. 2.South Carolina College of PharmacyMedical University of South Carolina Children’s HospitalCharlestonUSA
  3. 3.Independent Epidemiology ConsultantSaratogaUSA
  4. 4.College of MedicineMedical University of South CarolinaCharlestonUSA
  5. 5.Care Coordination Institute, Greenville Health SystemUniversity of South Carolina School of MedicineGreenvilleUSA
  6. 6.Division of Nephrology and HypertensionMedical University of South Carolina Children’s HospitalCharlestonUSA

Personalised recommendations