pediatrics
Hypertensive Emergencies in Children
Key Points
Hypertensive emergencies involve target organ dysfunction caused by elevated BP. Evaluate for target organ damage using ECG, urinalysis, serum electrolytes, bloodureanitrogen, creatinine, and, if neurologic symptoms are present, CT of the head. Admit to intensive care unit and consult a specialist in pediatric hypertension, treat with IV therapy, but do not delay treatment if these assets are not immediately available. Preferred drugs to use includelabetalolandnicardipine. Goal of initial therapy is to lower BP to stop end-organ damage quickly but not so fast as to cause hypoperfusion. BP should be lowered by 25% every 6 hours until the 95th percentile is approached and any related symptoms of target organ dysfunction are gone. Children who develop a severe hypertensive emergency on top of their chronic hypertension need a more cautious approach to lowering their BP. 