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 is defined as either systolic and/or diastolic BP ≥95th percentile measured upon three or more occasions. The degree of hypertension is further delineated by the two following stages:
●Stage 1 hypertension – Systolic and/or diastolic BP between the 95th percentile and 5 mmHg above the 99th percentile.
- Sorof JM, Lai D, Turner J, et al. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004; 113:475.
- Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298:874.
- Moore WE, Stephens A, Wilson T, et al. Body mass index and blood pressure screening in a rural public school system: the Healthy Kids Project. Prev Chronic Dis 2006; 3:A114.
- Kit BK, Kuklina E, Carroll MD, et al. Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999-2012. JAMA Pediatr 2015; 169:272.
- Lo JC, Sinaiko A, Chandra M, et al. Prehypertension and hypertension in community-based pediatric practice. Pediatrics 2013; 131:e415.
- Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560.
- Flanigan JS, Vitberg D. Hypertensive emergency and severe hypertension: what to treat, who to treat, and how to treat. Med Clin North Am 2006; 90:439.
- Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000; 356:411.
- Patel HP, Mitsnefes M. Advances in the pathogenesis and management of hypertensive crisis. Curr Opin Pediatr 2005; 17:210.
- Varon J, Marik PE. Clinical review: the management of hypertensive crises. Crit Care 2003; 7:374.
- Lassègue B, Griendling KK. Reactive oxygen species in hypertension; An update. Am J Hypertens 2004; 17:852.
- Endemann DH, Schiffrin EL. Endothelial dysfunction. J Am Soc Nephrol 2004; 15:1983.
- 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; 114:555.
- Flynn JT. Neonatal hypertension: diagnosis and management. Pediatr Nephrol 2000; 14:332.
- Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol 1995; 15:470.
- Gómez-Marín O, Prineas RJ, Råstam L. Cuff bladder width and blood pressure measurement in children and adolescents. J Hypertens 1992; 10:1235.
- Park MK, Menard SW, Yuan C. Comparison of auscultatory and oscillometric blood pressures. Arch Pediatr Adolesc Med 2001; 155:50.
- Fenves AZ, Ram CV. Drug treatment of hypertensive urgencies and emergencies. Semin Nephrol 2005; 25:272.
- Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular health in childhood: A statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002; 106:143.
- Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 111:697.
- Deal JE, Barratt TM, Dillon MJ. Management of hypertensive emergencies. Arch Dis Child 1992; 67:1089.
- Flynn JT. Evaluation and management of hypertension in childhood. Prog Pediatr Cardiol 2001; 12:177.
- Chandar J, Zilleruelo G. Hypertensive crisis in children. Pediatr Nephrol 2012; 27:741.
- Adelman RD. The hypertensive neonate. Clin Perinatol 1988; 15:567.
- Arar MY, Hogg RJ, Arant BS Jr, Seikaly MG. Etiology of sustained hypertension in children in the southwestern United States. Pediatr Nephrol 1994; 8:186.
- 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