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 the 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.
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- 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
- SUMMARY AND RECOMMENDATIONS