title: Malignant hypertension in children in India.
abstract: BACKGROUND
  Malignant hypertension is now an uncommon entity in the western world but still remains a significant problem in India. Therefore we studied the aetiological spectrum, management, and outcome of these patients.
  
  
  METHODS
  Forty consecutive children (<16 years) with malignant hypertension were admitted and investigated to exclude or confirm the secondary causes of hypertension. For acute control of blood pressure sublingual nifedipine was used in dosage of 0.3-0.6 mg/kg, failing which intravenous nitroglycerin was used. In patients with aortoarteritis with active disease, steroids were used. Angioplasty was carried out for renal artery stenosis whenever possible.
  
  
  RESULTS
  Renoparenchymal disease was the commonest cause of malignant hypertension, and was seen in 25 cases, renovascular hypertension in 13 cases (11 aortoarteritis and two fibromuscular dysplasia) and two had essential hypertension. For acute control of severe hypertension, sublingual nifedipine was effective in 92.5% of patients. Of the patients with renoparenchymal disease five became normotensive with treatment of the underlying disease, four received renal allograft, seven died, and nine are stable on antihypertensive drugs. Renal angioplasty was carried out in seven patients with renovascular hypertension (4 cured, 3 improved) and six are controlled on drugs.
  
  
  CONCLUSIONS
  We conclude that apart from renoparenchymal disease, aortoarteritis is a common cause of malignant hypertension in children. Sublingual nifedipine is effective for the rapid control of severe hypertension, and angioplasty is effective in aortoarteritis for short-term preservation of renal function and control of hypertension.
authors.affiliation: Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Arora
authors.forename: V
authors.initials: V
authors.lastname: Kher
authors.forename: P K
authors.initials: PK
authors.lastname: Rai
authors.forename: S
authors.initials: S
authors.lastname: Gulati
authors.forename: S S
authors.initials: SS
authors.lastname: Baijal
authors.forename: S
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D017130:Angioplasty; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006974:Hypertension, Malignant / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006978:Hypertension, Renovascular / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D007194:India; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D009543:Nifedipine / Q000627:therapeutic use; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000628:therapy
chemical_list: D000959:Antihypertensive Agents; D009543:Nifedipine