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TREATMENT OF ACUTE RISE OF BLOOD PRESSURE IN INFANTS AND CHILDREN WITH NIFEDIPINE

Eleven children aged 0.1 to 17 years (median 10 years) were treated with sublingual application of the calcium entry blocker nifedipine. Dose ranged between 0.22 to 0.76 mg/kg (mean 0.38 mg/kg). Nine children had renal hypertension, one pheochromocytoma and one aortic coarctation. Eight children were under chronic antihypertensive treatment. One hour following application of nifedipine systolic blood pressure fell significantly from 162±19 to 125±11 mmHg (x ± SD) and diastolic from 122±13 to 88±16 mmHg in 8 children with renal hypertension (aged 4 to 17 years). Blood pressure remained at this level for about 6 hours. Heart rate rose from 93±17 to 106±24 beats per min. 1 hour after nifedipine and returned to 96±15 4 hours after drug administration. Whereas plasma renin activity, plasma aldosterone and plasma arginine-vasopressin did not change in response to nifedipine, plasma noradrenaline rose significantly from 467±285 to 595±269pg/ml. In two infants (5 weeks and 7,5 months of age) systolic blood pressure fell by 40 and 50 mmHg, respectively. One child with pheochromocytoma had an excellent blood pressure response to nifedipine, however, the effect lasted only 4 hours. Nifedipine given sublingually was well tolerated also in infants and appears to be an effective and safe drug in the treatment of acute elevations of blood pressure.