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Hypertensive crisis in children and adolescents

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Abstract

Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician’s initial management of a hypertensive crisis. The main aim of the treatment of hypertensive crisis is the prevention or treatment of life-threatening complications of hypertension-induced organ dysfunction, including neurologic, ophthalmologic, renal, and cardiac complications. While the treatment strategy must be directed toward the immediate reduction of BP to reduce the hypertensive damage to these organs, it should not be at a too fast rate to cause hypoperfusion of vital organs by an excessively rapid reduction of BP. Thus, intravenous continuous infusions rather than intravenous boluses of antihypertensive medications should be the preferable mode of initial treatment of children with hypertensive emergency.

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Abbreviations

BP:

Blood pressure

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

LVH:

Left ventricular hypertrophy

HTN:

Hypertension

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Funding

This study was supported by the National Sustainability Program I (NPU I) Nr. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic.

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Correspondence to Tomáš Seeman.

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1. c; 2. a-2, b-4, c-1, d-3; 3. d; 4. b; 5. c

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Seeman, T., Hamdani, G. & Mitsnefes, M. Hypertensive crisis in children and adolescents. Pediatr Nephrol 34, 2523–2537 (2019). https://doi.org/10.1007/s00467-018-4092-2

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