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Approach to hypertensive emergencies and urgencies in children

Authors
Neil G Uspal, MD
Susan M Halbach, MD, MPH
Section Editors
George A Woodward, MD
F Bruder Stapleton, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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".)

EPIDEMIOLOGY

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'.)

DEFINITION

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 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 permits more time for evaluation and initial treatment with nonpharmacologic therapy unless the patient is symptomatic or has hypertensive target-organ damage. (See "Definition and diagnosis of hypertension in children and adolescents", section on 'Definition'.)

                       
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Literature review current through: Sep 2017. | This topic last updated: Sep 22, 2017.
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