Intravenous Hydralazine in Hospitalized Children and Adolescents with Hypertension.
OBJECTIVE
To explore the efficacy and safety of intravenous (IV) hydralazine in hospitalized children with hypertension.


METHODS
Data were retrospectively collected on hospitalized children treated with IV hydralazine. Percent changes in blood pressure (BP) were calculated, and linear regression was used to investigate associations between BP change and pertinent clinical and demographic variables. Bivariate logistic regression was used to investigate associations between the same covariates and the outcomes of ideal clinical response (ICR), a 10%-25% reduction in mean arterial pressure (MAP), and excess response (ER), a 25% reduction in MAP.


RESULTS
A total of 141 initial doses of IV hydralazine (median dose, 0.10 mg/kg [IQR, 0.09-0.11; range, 0.02-0.37]) were analyzed. Median age was 8 years (IQR, 2-15; range, 0-24); most patients had renal disease, malignancy, or were organ transplant recipients. The mean MAP reduction was 19% ± 12%. An ICR occurred in 66 patients (47%). Higher initial MAP and increased hydralazine dose were associated with greater percentage decrease in MAP. No association was found between ICR and the covariates of interest; higher initial MAP was associated with greater odds of ICR. ER occurred in 44 children (31%). Among this group, higher initial MAP and higher hydralazine dose were associated with increased odds of ER, and administration of other antihypertensive drugs was associated with decreased odds of ER. Four adverse effects possibly related to IV hydralazine, including 2 episodes of hypotension, were recorded.


CONCLUSIONS
IV hydralazine reduced BP in the majority of children. However, a substantial proportion of children experienced potentially excessive BP reduction.
Division of Nephrology, Seattle Children's Hospital, Seattle, WA. Electronic address: joseph.flynn@seattlechildrens.org.
Joseph T
JT
Flynn
Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
Miranda C
MC
Bradford
Department of Pharmacy, Seattle Children's Hospital, Seattle, WA.
Eric M
EM
Harvey
D061605:Administration, Intravenous; D000293:Adolescent; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult
D000959:Antihypertensive Agents; D006830:Hydralazine