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Review
. 2014 Apr;16(4):425.
doi: 10.1007/s11906-014-0425-0.

Therapy of acute hypertension in hospitalized children and adolescents

Tennille N Webb  1 , Ibrahim F Shatat, Yosuke Miyashita
Affiliations
Review

Therapy of acute hypertension in hospitalized children and adolescents

Tennille N Webb et al. Curr Hypertens Rep. 2014 Apr.

Abstract

Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios.

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Figures

Figure 1
Figure 1
Altered cerebral perfusion auto-regulation (indicated by the dotted line) in chronic hypertension. Copyright permission obtained from reference [4]
Figure 2
Figure 2
Proposed algorithm for management of acute hypertension in children and adolescents. Copyright permission obtained and adapted from [4]. CHF: congestive heart failure, IV: intravenous, PO: oral, GN: glomerulonephritis, NE: neuroendocrine, BP: blood pressure
See this image and copyright information in PMC

References

    1. Patel HP, Mitsnefes M. Advances in the pathogenesis and management of hypertensive crisis. Curr Opin Pediatr. 2005;17:210–4. - PubMed
    1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76. - PubMed
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    1. Flynn JT, Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol. 2009;24:1101–12. This review provides detailed assessment of the pathophysiology of acute hypertension, including discussion and illustration of cerebral perfusion auto-regulation. This review also provides many of the agent and their doses used to treat hypertensive crisis including some of the newer agents.. - PubMed
    1. Thomas CA. Drug treatment of hypertensive crisis in children. Pediatric Drugs. 2011;13(5):281–90. This review provides the pathogenesis and treatment goals of hypertensive crisis. This is also a good summary of antihypertensive agents used in hypertensive crisis including their mechanism of action, recommended doses and adverse effects. - PubMed

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