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Evaluation and management of pediatric hypertensive crises: hypertensive urgency
and hypertensive emergencies
#MMPMID27147865
Patel NH
; Romero SK
; Kaelber DC
Open Access Emerg Med
2012[]; 4
(?): 85-92
PMID27147865
show ga
Hypertension (HTN) in the pediatric population is estimated to have a world-wide
prevalence of 2%-5%. As with adults, pediatric patients with HTN can present with
hypertensive crises include hypertensive urgency and hypertensive emergencies.
However, pediatric blood pressure problems have a greater chance of being from
secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough
evaluation of a child with a hypertensive emergency includes accurate blood
pressure readings, complete and focused symptom history, and appropriate past
medical, surgical, and family history. Physical exam should include height,
weight, four-limb blood pressures, a general overall examination and especially
detailed cardiovascular and neurological examinations, including fundoscopic
examination. Initial work-up should typically include electrocardiography, chest
X-ray, serum chemistries, complete blood count, and urinalysis. Initial
management of hypertensive emergencies generally includes the use of intravenous
or oral antihypertensive medications, as well as appropriate, typically
outpatient, follow-up. Emergency department goals for hypertensive crises are to
(1) safely lower blood pressure, and (2) treat/minimize acute end organ damage,
while (3) identifying underlying etiology. Intravenous antihypertensive
medications are the treatment modality of choice for hypertensive emergencies
with the goal of reducing systolic blood pressure by 25% of the original value
over an 8-hour period.
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