Isradipine for treatment of acute hypertension in hospitalized children and adolescents.
Severe acute hypertension in pediatric patients requires prompt and controlled blood pressure (BP) reduction to prevent end-organ damage. The authors aimed to examine the efficacy and safety of isradipine, an orally administered second-generation dihydropyridine calcium channel blocker, for treatment of acute hypertension in hospitalized pediatric patients. A retrospective analysis of 391 doses of isradipine administered to 282 patients (58% boys) with acute hypertension and median age of 12.8 years (range, 0.1-21.9) was performed. Primary diagnoses included renal disease (n=154), malignancy (45), nonrenal transplant (37), neurologic disease (21), and other (25). The decrease in systolic BP was 16.3%±11.6% (mean ± SD) and diastolic BP was 24.2%±17.2%. BPs were significantly lower in all age groups and in all diagnosis categories following isradipine administration. The decrease in BP was the highest in children younger than 2 years. The mean increase in pulse after a dose was 7±17 beats per minute. Forty adverse events were reported in 33 patients, with emesis and nausea being the most common; 5 of these events were hypotension. The authors conclude that isradipine effectively reduces BP in a wide variety of hospitalized children and adolescents with acute hypertension. A lower initial dose of 0.05 mg/kg may be appropriate in children younger than 2 years.
Division of Nephrology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 15224, USA. yosuke.miyashita@chp.edu
Yosuke
Y
Miyashita
Do
D
Peterson
Jane M
JM
Rees
Joseph T
JT
Flynn
D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D017275:Isradipine / Q000008:administration & dosage / Q000009:adverse effects; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D009369:Neoplasms / Q000150:complications; D009422:Nervous System Diseases / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D014180:Transplantation / Q000009:adverse effects; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D017275:Isradipine