Skip to main content
Log in

Pediatric Hypertensive Emergencies

  • Hypertensive Emergencies (BM Baumann, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Hypertensive emergency is a life-threatening condition that requires immediate evaluation and treatment. In children, severe hypertension can be caused by a variety of different underlying conditions. It usually presents with neurological involvement; however, signs and symptoms of injury to the kidneys, myocardium and eyes can also be present. Hospitalization for intravenous treatment with antihypertensive(s) and close monitoring in an intensive care setting are required for these patients. Few studies in children with hypertensive emergency have been done in the last several years. The findings and observations of these studies are discussed in this review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wu H, Yang W, Wu Y, Zhao L, Chen C, Fu Y. Clinical significance of blood pressure ratios in hypertensive crisis in children. Arch Dis Child. 2012;97:200–5. This retrospective study is one of the few original studies done in children with severe hypertension over the last 3 years. The study included 110 children from 2 pediatric emergency departments. The authors calculated blood pressure ratios and correlated these with cause and severity of hypertension.

    Article  Google Scholar 

  2. Deshmukh A, Pant S, Kumar G, Murugiah K, Mehta J. Seasonal variation in hypertensive emergency hospitalization. J Clin Hypertens. 2012;14(4):269–70.

    Article  Google Scholar 

  3. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–76.

    Article  Google Scholar 

  4. Yang W, Zhao L, Chen C, Wu Y, Chang Y, Wu H. First-attack pediatric hypertensive crisis presenting to the pediatric emergency department. Br Med J Pediatr. 2012;12:200–7. This small single-center retrospective study describes the most common underlying causes of hypertension and most common presenting symptoms in children with hypertensive crisis.

    Google Scholar 

  5. Chandar J, Zilleruelo G. Hypertensive crisis in children. Pediatr Nephrol. 2012;27:741–51. This review discusses the etiology of acute severe hypertension in children, classifying possible etiologies by age group. It also talks about the workup and management of these patients.

    Article  Google Scholar 

  6. Singh D, Akingbola O, Yosypiv I, El-Dahr S. Emergency management of hypertension in children. Int J Nephrol. 2012;2012:1–15. This comprehensive review discusses the pathophysiology, causes and clinical manifestations of hypertension in children as well as the treatment approach to acute management.

    Article  Google Scholar 

  7. Derhaschnig U, Testori C, Riedmueller E, Aschauer S, Wolzt M, Jilma B. Hypertensive emergencies are associated with elevated markers of inflammation, coagulation, platelet activation and fibrinolysis. J Hum Hypertens. 2013;27:368–73.

    Article  CAS  Google Scholar 

  8. Harrison D, Guzik T, Lob H, Madhur M, Marvar P, Thabet S, et al. Inflammation, immunity, and hypertension. Hypertension. 2011;57:132–40.

    Article  CAS  Google Scholar 

  9. Chamarthi B, Williams G, Ricchiuti V, Srikumar N, Hopkins P, Luther J, et al. Inflammation and hypertension: the interplay of interleukin-6, dietary sodium and the renin-angiotensin system in humans. Am J Hypertens. 2011;24(10):1143–8.

    Article  CAS  Google Scholar 

  10. Karabacak M, Dogan A, Turkdogan A, Kapci M, Duman A, Akpinar O. Mean platelet volume is increased in patients with hypertensive crises. Platelets. 2013;epub:1-4.

  11. Sanford E, Stein J. Hypertensive encephalopathy presenting as status epilepticus in a three year old. J Emerg Med. 2012;42(6):e141–5.

    Article  Google Scholar 

  12. Lin K, Hsu W, Wang H, Lui T. Hypertension-induced cerebellar encephalopathy and hydrocephalus in a male. Pediatr Neurol. 2006;34:72–5.

    Article  Google Scholar 

  13. Ishikura K, Hamasaki Y, Sakai T, Hataya H, Mak R, Honda M. Posterior reversible encephalopathy syndrome in children with kidney diseases. Pediatr Nephrol. 2012;27:375–84.

    Article  Google Scholar 

  14. Siebert E, Spors B, Bohner G, Endres M, Liman T. Posterior reversible encephalopathy syndrome in children: radiological and clinical findings - a retrospective analysis of a German tertiary care center. Eur J Paediatr Neurol. 2013;17:169–75.

    Article  CAS  Google Scholar 

  15. Endo A, Fuchigami T, Hasegawa M, Hashimoto K, Fujita Y, Inamo Y, et al. Posterior reversible encephalopathy syndrome in childhood. Pediatr Emerg Care. 2012;28(2):153–7.

    Article  Google Scholar 

  16. Chen T, Lin W, Tseng Y, Tseng C, Chang T, Lin T. Posterior reversible encephalopathy syndrome in children: case series and systematic review. J Clin Neurol. 2013;28(11):1378–86.

    Google Scholar 

  17. Henderson A, Biousse V, Newman NJ, Lamirel C, Wright D, Bruce B. Grade III or grade IV hypertensive retinopathy with severely elevated blood pressure. Western. J Emerg Med. 2012;13(6):529–34.

    Google Scholar 

  18. Williams K, Shah A, Morrison D, Sinha M. Hypertensive retinopathy in severely hypertensive children: demographic, clinical, and ophthalmoscopic findings from a 30-year British cohort. J Pediatr Ophthalmol Strabismus. 2013;50(4):222–8.

    Article  Google Scholar 

  19. Wijaya I, Siregar P. Hypertensive crises in the adolescent: evaluation of suspected renovascular hypertension. Acta Medica Indonesiana - Indones J Intern Med. 2013;45(1):49–54.

    Google Scholar 

  20. Tibbetts M, Wise R, Forbes B, Hedrick H, Levin A. Hypertensive retinopathy in a child caused by pheochromocytoma: identification after a failed school vision screening. J Am Assoc Pediatr Ophthalmol Strabismus. 2011;16:97–9. This case report highlights the importance of blood pressure measurement and fundus examination in children with vision complaints.

    Article  Google Scholar 

  21. Derhaschnig U, Testori C, Riedmueller E, Hobl E, Mayr F, Jilma B. Decreased renal function in hypertensive emergencies. Journal of Human Hypertension. 2014;epub ahead of print.

  22. Kovalski Y, Cleper R, Krause I, Dekel B, Belenky A, Davidovits M. Hyponatremic hypertensive syndrome in pediatric patients: is it really so rare? Pediatr Nephrol. 2012;27:1037–40.

    Article  Google Scholar 

  23. Flynn J, Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol. 2009;24:1101–12.

    Article  Google Scholar 

  24. Sahney S. A review of calcium channel antagonists in the treatment of pediatric hypertension. Pediatr Drugs. 2006;8(6):357–73.

    Article  Google Scholar 

  25. Thomas C. Drug treatment of hypertensive crisis in children. Pediatr Drugs. 2011;13(5):281–90. This review provides a thorough discussion of the most commonly used oral and intravenous medications in children with severe hypertension, including mechanism of action, doses and disadvantages of each medication.

    Article  Google Scholar 

  26. Flynn J, Mottes T, Brophy P, Kershaw D, Smoyer W, Bunchman T. Intravenous nicardipine for treatment of severe hypertension in children. J Pediatr. 2001;139:38–43.

    Article  CAS  Google Scholar 

  27. Tenney F, Sakarcan A. Nicardipine is a safe and effective agent in pediatric hypertensive emergencies. Am J Kidney Dis. 2000;35(5):E20.

    Article  CAS  Google Scholar 

  28. Thomas C, Moffett B, Wagner J, Mott A, Feig D. Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children. Pediatr Crit Care Med. 2011;12:28–32. This retrospective study compares labetalol to nicardipine and nitroprusside. In addition to suggesting that labetalol is safe and effective for young children with hypertension, it suggests that this medication should be used at lower doses in this age group.

    Article  Google Scholar 

  29. Hammer G, Connolly S, Schulman S, Lewandowski A, Cohane C, Reece T, et al. Sodium nitroprusside is not associated with metabolic acidosis during intraoperative infusion in children. BMC Anesthesiol. 2013;13:1–8.

    Article  Google Scholar 

  30. Patel H, Mitsnefes M. Advances in the pathogenesis and management of hypertensive crisis. Curr Opin Pediatr. 2005;17:210–4.

    Article  Google Scholar 

  31. Baszak R, Savage J, Ellis E. The use of short-acting nifedipine in pediatric patients with hypertension. J Pediatr. 2001;139(1):34–7.

    Article  Google Scholar 

  32. Egger D, Deming D, Hamada N, Perkin R, Sahney S. Evaluation of the safety of short-acting nifedipine in children with hypertension. Pediatr Nephrol. 2002;17(1):35–40.

    Article  Google Scholar 

  33. Miyashita Y, Peterson D, Rees J, Flynn J. Isradipine for treatment of acute hypertension in hospitalized children and adolescents. J Clin Hypertens. 2010;12:850–5.

    Article  CAS  Google Scholar 

  34. Webb T, Shatat I, Miyashita Y. Therapy of acute hypertension in hospitalized children and adolescents. Curr Hypertens Rep. 2014;16:425–33. This review focuses on the treatment of acute hypertension in children, including oral and intravenous antihypertensives used in children, and proposes an algorithm for the same.

    Article  Google Scholar 

  35. Anderson J, Adams C, Antman E, Bridges C, Califf R, Casey D, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society fo Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116:803–77.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tej K. Mattoo.

Ethics declarations

Conflict of Interest Rossana Baracco declares that she has no conflict of interest.

Tej K. Mattoo has received grants from NIH/NIDDK and honorarium payments from UpToDate.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Hypertensive Emergencies

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baracco, R., Mattoo, T.K. Pediatric Hypertensive Emergencies. Curr Hypertens Rep 16, 456 (2014). https://doi.org/10.1007/s11906-014-0456-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-014-0456-6

Keywords

Navigation