pediatrics
Hypertensive Emergencies in Children
Introduction
A hypertensive emergency is severe hypertension with manifestations of damage to target organs (primarily the brain, eyes, cardiovascular system, and kidneys). Hypertensive emergencies are relatively rare in children, occurring in about 2 per 10,000 emergency department visits ( General reference ). Diagnosis is by blood pressure measurement and tests for target organ damage, including ECG, urinalysis, and serum blood (See also Hypertension in Children and In the past, severe hypertensionwithouttarget organ damage was called a hypertensive urgency, and severe hypertensionwithend-organ dysfunction or damage was called a hypertensive emergency. The separation of these two clinical states is somewhat arbitrary because a hypertensive urgency can progress to an emergency. Today, the preferred term is "acute severe hypertension," but the terms "urgency" and "emergency" are still used in clinical practice. suggest that physicians should be concerned about acute target organ damage in patients whose blood pressure (BP) measurement is ≥ 30 mm Hg above the 95th percentile based on age, sex, and height (see BP percentile level tables for Blood Pressure (BP) Percentile Levels for Boys by Age and Height (Measured and Percentile) and Importantly, children with acute secondary hypertension (particularly due to Acute glomerulonephritis ) can be symptomatic and even develop encephalopathy at BP levels that would be considered mild in a hypertensive adult or adolescent because, in addition to the BP level, the rate of rise is important because there is less time for the organ systems to adapt to the hypertension. Marked BP elevation can affect several organ systems. The most common and critical are the Brain: Hypertensive encephalopathy Eyes: Retinal changes Heart: Left ventricular heart failure Kidneys: Renal insufficiency (elevated creatinine) 