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 — 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 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 two stages (table 1). The definition and diagnosis of hypertension in children is discussed in detail separately. (See "Definition and diagnosis of hypertension in children and adolescents", section on 'Definition'.)
Severity — The decision process for evaluation and treatment varies with the severity of the hypertension. Stage 2 identifies those children who need more prompt evaluation and immediate pharmacologic treatment, while stage 1 hypertension allows for more time for evaluation and initial treatment with nonpharmacologic therapy unless the patient is symptomatic or has hypertensive target-organ damage. (See "Nonemergent treatment of hypertension in children and adolescents", section on 'Nonpharmacologic therapy' and "Nonemergent treatment of hypertension in children and adolescents", section on 'Pharmacologic therapy'.)
While there is no specific numerical value or BP percentile that identifies “acute severe hypertension” in youth, in one relatively large case series of pediatric patients with acute severe hypertension, most patients had BP readings well in excess of stage 2 hypertension . The newest guidance from the AAP suggests that clinicians be concerned about hypertensive complications in patients with BP values >30 mmHg above the 95th percentile (figure 1A-B and table 2 and table 3).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:
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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