Approach to hypertensive emergencies and urgencies in children
- Neil G Uspal, MD
Neil G Uspal, MD
- Assistant Professor of Pediatric Emergency Medicine
- University of Washington
- Attending Physician
- Seattle Children's Hospital
- Susan M Halbach, MD, MPH
Susan M Halbach, MD, MPH
- Assistant Professor of Pediatric Medicine
- Seattle Children’s Hospital
- Section Editors
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- F Bruder Stapleton, MD
F Bruder Stapleton, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Nephrology
- Professor and Chair, Department of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic addresses the diagnostic approach to hypertensive emergencies in children. The treatment of pediatric hypertensive emergencies is discussed separately. (See "Management of hypertensive emergencies and urgencies in children".)
Hypertension, defined as either systolic and/or diastolic BP ≥95th percentile measured upon three or more occasions, is present in 2 to 5 percent of the pediatric population and is frequently undiagnosed [1-5]. However, hypertensive emergencies in children occur in fewer than 1 percent of emergency department (ED) visits. (See "Epidemiology, risk factors, and etiology of hypertension in children and adolescents", section on 'Epidemiology'.)
Proper management of children with elevated BP requires working knowledge of pediatric BP standards and a clear understanding of when elevated BP requires emergent, urgent, or routine care.
Hypertension in children — Hypertension in children is defined as either systolic and/or diastolic blood pressure (BP) ≥95th percentile measured upon three or more occasions. As in adults, hypertension in children is further divided into two stages (table 1). The definition and diagnosis of hypertension in children is discussed in detail separately. (See "Definition and diagnosis of hypertension in children and adolescents", section on 'Definition'.)
Severity — The decision process for evaluation and treatment varies with the severity of the hypertension. Stage 2 identifies those children who need more prompt evaluation and immediate pharmacologic treatment, while stage 1 hypertension permits more time for evaluation and initial treatment with nonpharmacologic therapy unless the patient is symptomatic or has hypertensive target-organ damage. (See "Definition and diagnosis of hypertension in children and adolescents", section on 'Definition'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Hypertension in children
- - Severity
- Hypertensive emergency
- - Hypertensive encephalopathy
- Hypertensive urgency
- Symptoms of end organ damage
- Other features
- Physical examination
- - Blood pressure measurement
- - Signs of end organ damage
- - Other signs
- ANCILLARY STUDIES
- ETIOLOGY OF HYPERTENSIVE EMERGENCY
- Confirm elevated BP
- Establish severity of hypertension
- Exclude other causes of hypertension
- Treat hypertensive emergency