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 — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- 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.
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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