Management of hypertension in infants
- Joseph T Flynn, MD, MS
Joseph T Flynn, MD, MS
- Professor of Pediatrics
- University of Washington
The optimal management for hypertension in infants remains uncertain due to the lack of evidence regarding long-term outcome and clinical trials evaluating the safety and efficacy of antihypertensive agents in this age group. As a result, therapeutic recommendations generally rely on expert opinion based on clinical experience and judgment.
This topic reviews the management of hypertension in infants, including a suggested approach for initiating pharmacologic therapy. The etiology, evaluation, and diagnosis of hypertension in neonates and older infants are discussed separately. (See "Etiology, clinical features, and diagnosis of neonatal hypertension" and "Evaluation and diagnosis of hypertension in infants between one month and one year of age".)
●Infants include all individuals who are less than 12 months of age and include neonates.
●Neonates are newborn infants between 0 to 30 days of age.
Although data are limited regarding the treatment of hypertension in infants, the approach to management is similar to that used in older children, except for nonpharmacologic management, which is important in older children but has no/very limited role in infants. Decisions are based on the severity of hypertension, the underlying cause, and other clinical factors that impact the well-being of the patient.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:
- Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome. Pediatr Nephrol 2012; 27:17.
- Gouyon JB, Geneste B, Semama DS, et al. Intravenous nicardipine in hypertensive preterm infants. Arch Dis Child Fetal Neonatal Ed 1997; 76:F126.
- Wells TG, Bunchman TE, Kearns GL. Treatment of neonatal hypertension with enalaprilat. J Pediatr 1990; 117:664.
- O'Dea RF, Mirkin BL, Alward CT, Sinaiko AR. Treatment of neonatal hypertension with captopril. J Pediatr 1988; 113:403.
- Milou C, Debuche-Benouachkou V, Semama DS, et al. Intravenous nicardipine as a first-line antihypertensive drug in neonates. Intensive Care Med 2000; 26:956.
- Tobias JD. Nicardipine to control mean arterial pressure after cardiothoracic surgery in infants and children. Am J Ther 2001; 8:3.
- Flynn JT, Warnick SJ. Isradipine treatment of hypertension in children: a single-center experience. Pediatr Nephrol 2002; 17:748.
- Watkinson M. Hypertension in the newborn baby. Arch Dis Child Fetal Neonatal Ed 2002; 86:F78.
- Edstrom CS, Christensen RD. Evaluation and treatment of thrombosis in the neonatal intensive care unit. Clin Perinatol 2000; 27:623.
- Kiessling SG, Wadhwa N, Kriss VM, et al. An unusual case of severe therapy-resistant hypertension in a newborn. Pediatrics 2007; 119:e301.
- Dionne JM, Flynn JT. Management of severe hypertension in the newborn. Arch Dis Child 2017; 102:1176.
- Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140.
- Blowey DL, Duda PJ, Stokes P, Hall M. Incidence and treatment of hypertension in the neonatal intensive care unit. J Am Soc Hypertens 2011; 5:478.
- Sahu R, Pannu H, Yu R, et al. Systemic hypertension requiring treatment in the neonatal intensive care unit. J Pediatr 2013; 163:84.
- Seliem WA, Falk MC, Shadbolt B, Kent AL. Antenatal and postnatal risk factors for neonatal hypertension and infant follow-up. Pediatr Nephrol 2007; 22:2081.
- Friedman AL, Hustead VA. Hypertension in babies following discharge from a neonatal intensive care unit. A 3-year follow-up. Pediatr Nephrol 1987; 1:30.
- Lanzarini VV, Furusawa EA, Sadeck L, et al. Neonatal arterial hypertension in nephro-urological malformations in a tertiary care hospital. J Hum Hypertens 2006; 20:679.
- Jenkins RD, Aziz JK, Gievers LL, et al. Characteristics of hypertension in premature infants with and without chronic lung disease: a long-term multi-center study. Pediatr Nephrol 2017; 32:2115.
- Tack ED, Perlman JM. Renal failure in sick hypertensive premature infants receiving captopril therapy. J Pediatr 1988; 112:805.
- Perlman JM, Volpe JJ. Neurologic complications of captopril treatment of neonatal hypertension. Pediatrics 1989; 83:47.
- Guron G, Friberg P. An intact renin-angiotensin system is a prerequisite for normal renal development. J Hypertens 2000; 18:123.
- Mulla H, Tofeig M, Bu'Lock F, et al. Variations in captopril formulations used to treat children with heart failure: a survey in the United kingdom. Arch Dis Child 2007; 92:409.
- Mulla H, Hussain N, Tanna S, et al. Assessment of liquid captopril formulations used in children. Arch Dis Child 2011; 96:293.
- Adamson PC, Rhodes LA, Saul JP, et al. The pharmacokinetics of esmolol in pediatric subjects with supraventricular arrhythmias. Pediatr Cardiol 2006; 27:420.
- Wiest DB, Garner SS, Uber WE, Sade RM. Esmolol for the management of pediatric hypertension after cardiac operations. J Thorac Cardiovasc Surg 1998; 115:890.
- Flynn JT, Mottes TA, Brophy PD, et al. Intravenous nicardipine for treatment of severe hypertension in children. J Pediatr 2001; 139:38.
- Nakagawa TA, Sartori SC, Morris A, Schneider DS. Intravenous nicardipine for treatment of postcoarctectomy hypertension in children. Pediatr Cardiol 2004; 25:26.
- Miyashita Y, Peterson D, Rees JM, Flynn JT. Isradipine for treatment of acute hypertension in hospitalized children and adolescents. J Clin Hypertens (Greenwich) 2010; 12:850.
- Flynn JT. Safety of short-acting nifedipine in children with severe hypertension. Expert Opin Drug Saf 2003; 2:133.
- Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part I. Clin Pharmacokinet 1998; 34:457.
- Adelman RD. Long-term follow-up of neonatal renovascular hypertension. Pediatr Nephrol 1987; 1:35.
- Caplan MS, Cohn RA, Langman CB, et al. Favorable outcome of neonatal aortic thrombosis and renovascular hypertension. J Pediatr 1989; 115:291.
- CORRECTING UNDERLYING CAUSE
- APPROACH TO PHARMACOLOGIC TREATMENT
- Who should be treated?
- - Mild hypertension
- - Asymptomatic moderate hypertension
- - Severe symptomatic hypertension
- Target BP goal
- PHARMACOLOGIC AGENTS
- - Approach for anti-hypertensive drug therapy
- ACE inhibitors
- Beta blockers
- Calcium channel blockers
- - Hydralazine
- - Minoxidil
- - Sodium nitroprusside
- ONGOING MANAGEMENT
- Duration of treatment and course
- LONG-TERM OUTCOME
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS