Adverse neurologic events associated with rebound hypertension after using short-acting nifedipine in childhood hypertension.
BACKGROUND
Short-acting nifedipine (SA-NIF) is widely prescribed for acute hypertension (HTN) in children despite reports of ischemic complications in adults. We describe two children with neurologic events caused by rebound hypertension following SA-NIF use.


METHODS
Patient 1 is a 7-year-old with acute nephritis and blood pressure (BP) of 185/130. She received SA-NIF which decreased BP to 114/79. When BP rebounded to 160/103, she developed severe cortical visual impairment. Head CT demonstrated edema and petechial hemorrhages in the watershed region. Patient 2 is a 10-year-old renal transplant recipient who received SA-NIF for a BP of 155/98, which resulted in a prompt decrease to 114/74. Two hours later he developed aphasia and right-sided neglect. His BP increased to 168/88 and he developed partial complex seizures. Brain MRI showed high signal intensity in the watershed areas with early gadolinium enhancement.


CONCLUSIONS
The temporal association of the neurologic events with the rebound increase in BP suggests a possible role for the SA-NIF, consistent with its pharmacokinetic profile. Although the adult literature has focused on the unpredictable decline in BP after SA-NIF treatment, these cases suggest that rapid increases in BP following the maximal SA-NIF effect may be associated with impaired cerebral autoregulation and encephalopathy in children. These cases underscore the need for frequent blood pressure determinations and therapy to prevent rebound hypertension.
Leonard
M B
MB
Department of Pediatrics, The Children's Hospital of Philadelphia, PA 19104, USA. leonard@email.chop.edu
Kasner
S E
SE
Feldman
H I
HI
Schulman
S L
SL
D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D020343:Hypertensive Encephalopathy / Q000139:chemically induced* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009543:Nifedipine / Q000009:adverse effects* / Q000493:pharmacokinetics; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000493:pharmacokinetics
D014665:Vasodilator Agents; D009543:Nifedipine