[Hypertensive crisis in children and adolescents].
Hypertensive crisis is a sudden rise in blood pressure above 99 c. for sex, age and height +5 mm Hg. Depending on patient's symptoms, hypertensive crisis can be divided into hypertensive emergency severe arterial hypertension with target organ insufficiency and/r damage (central nervous system, heart, kidney, eye), and hypertensive urgency - severe arterial hypertension without target organ insufficiency and damage with non-specific symptoms like: headaches, vertigo, nasal bleeding, nausea, and vomiting. The most common causes of hypertensive crisis in neonates and infants are renal artery thrombosis, broncho-pulmonary dysplasia, and coarctation of aorta; in older children - kidney diseases and renal artery stenosis. In neonates and infants symptoms of cardiac failure predominate, whereas in older children symptoms from central nervous system (headaches, nausea, vomiting, changes in level of consciousness, seizures, focal deficits). Hypertensive crisis is treated with fast- and short-acting medications; 25% reduction of blood pressure within first 8 hours is recommended, with complete normalization within 24-48 hours. Hypertensive emergency should be treated with intravenous agents (labetalol, hydralazine, nicardipine, and sodium nitroprusside), hypertensive urgency with intravenous or oral agents like nifedipine, isradipine, clonidine and minoxidil. Nicardipine is a first-choice medication in neonates.
Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland. pskrzyp@gmail.com
Piotr
P
Skrzypczyk
Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland.
Maria
M
Roszkowska-Blaim
Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland.
Maria
M
Daniel
D000293:Adolescent; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001017:Aortic Coarctation / Q000150:complications; D001997:Bronchopulmonary Dysplasia; D002648:Child; D004630:Emergencies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D007674:Kidney Diseases / Q000150:complications; D012078:Renal Artery Obstruction / Q000150:complications
D000959:Antihypertensive Agents