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Management of hypertensive emergencies and urgencies in children

Author
Joseph T Flynn, MD, MS
Section Editors
George A Woodward, MD
F Bruder Stapleton, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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".)

DEFINITION

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 [3]. 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) [4,5].

                         
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Literature review current through: Nov 2017. | This topic last updated: Dec 12, 2017.
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References
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