Pediatric Nephrology

, Volume 27, Issue 5, pp 741–751 | Cite as

Hypertensive crisis in children

  • Jayanthi Chandar
  • Gastón ZillerueloEmail author
Educational Review


Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure. Precipitous drops in blood pressure can result in impairment of perfusion of vital organs. Medications commonly used to treat hypertensive crisis in children are nicardipine, labetalol and sodium nitroprusside. In this review, we discuss the pathophysiology, differential diagnosis and recent developments in management of hypertensive crisis in children.


Hypertension Hypertension crisis Hypertensive urgency Children Antihypertensive therapy 



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© IPNA 2011

Authors and Affiliations

  1. 1.Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children’s HospitalUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Division of Pediatric NephrologyUniversity of Miami/ Holtz Children’s HospitalMiamiUSA

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