Management of hypertensive emergencies and urgencies in children
- Joseph T Flynn, MD, MS
Joseph T Flynn, MD, MS
- Professor of Pediatrics
- University of Washington
- 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)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Acute severe hypertension resulting in hypertensive emergencies and urgencies occurs infrequently in children. Proper management of this potentially life-threatening condition and prevention of its complications depend on prompt recognition and treatment.
The clinician should understand that there is a spectrum of severity of acute hypertension. Any classification scheme that divides the clinical presentation of acute severe hypertension into "urgent" or "emergent" is by its nature arbitrary [1,2]. Clinical findings, especially symptoms manifested by the patient, must be used to gauge the severity of acute hypertension and guide management.
This topic discusses the rapid assessment and treatment of hypertensive emergencies and urgencies in children. The diagnostic evaluation to acute severe hypertension is discussed separately. (See "Approach to hypertensive emergencies and urgencies in children".)
Acute severe hypertension has traditionally been divided into hypertensive emergencies and hypertensive urgencies. The clinician should understand that there is a spectrum of severity of acute hypertension. Any classification scheme that divides the clinical presentation of acute severe hypertension into separate categories is by its nature arbitrary [1,2]. Clinical judgment must be used to gauge the severity of acute hypertension and guide management.
Hypertension — 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 the two following stages:
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- - Severity
- Hypertensive emergency
- Hypertensive urgency
- Confirmation of severe hypertension
- General measures
- Blood pressure management
- - Hypertensive emergency goal
- - Hypertensive urgency goal
- Mode of administration
- First line intravenous agents
- Other intravenous agents
- Use of oral antihypertensive agents
- Ongoing antihypertensive therapy
- SPECIFIC PEDIATRIC HYPERTENSIVE EMERGENCIES
- Hypertensive encephalopathy
- Renal disease
- Neonatal hypertension
- Coarctation of the aorta
- Cocaine or amphetamine overdose
- Pheochromocytomas and paragangliomas
- SUMMARY AND RECOMMENDATIONS
- Management of hypertensive emergency
- Management of hypertensive urgency