A hypertensive emergency is a particularly severe, sudden form of high blood pressure. Diastolic blood pressure (the bottom number) is usually over 100 mm Hg, and there is evidence of progressive damage in one or more vital organs (typically the brain, heart, eyes, and kidneys). Children may have a variety of symptoms.
Hypertensive emergencies are relatively rare in children. They may develop in children who have or have not been previously diagnosed with high blood pressure.
Hypertensive emergencies usually occur when blood pressure rapidly increases. What causes the rapid increase varies by age.
The most common causes are:
- During infancy: Birth defects of the kidneys, bronchopulmonary dysplasia, coarctation of the aorta, renal vein thrombosis, and other disorders that affect the blood vessels to the kidneys
- During childhood: Kidney tissue disease, disorders that affect the blood vessels to the kidneys, hormonal disorders, drugs, and toxins
- During adolescence: Kidney tissue disease, not taking drugs they were prescribed for their high blood pressure, and use of drugs such as stimulants (for example, amphetamines and cocaine), anabolic steroids, corticosteroids, or certain oral contraceptives (birth control pills)
A hypertensive emergency, if not treated promptly, typically causes progressive damage in one or more vital organs, particularly the following:
- Brain, which can result in deterioration of brain function, seizures, and/or coma
- Heart, which can result in heart failure.
- Eyes, which can result in papilledema (swelling of the optic nerve) and bleeding in the retina.
- Kidneys, which can result in kidney dysfunction or failure.
If untreated, a hypertensive emergency can be fatal.
Common symptoms hypertension in children
- Headache lethargy (lethargy), confusion, seizures, and in infants, irritability.
- Children may become comatose.
- Children may have a rapid heart rate, chest pain, shortness of breath, and/or swollen ankles. Vision may be impaired.
Treatment of Hypertensive Emergencies in Children
- For hypertensive emergencies, admission to an intensive care unit and intravenous drugs to lower blood pressure
- For hypertensive urgencies, admission to an emergency department or hospital and oral drugs to lower blood pressure (occasionally intravenous drugs are needed)
Children with a hypertensive emergency are rapidly admitted to an intensive care an emergency department so that they can be quickly treated and evaluated and monitored closely. There, drugs to lower blood pressure (antihypertensive drugs) can be given by vein (intravenously) as soon as possible.
The goal of treatment of hypertensive emergencies is to lower blood pressure enough to eliminate the risk of life-threatening symptoms and to stop further damage to vital organs.
For hypertensive emergencies, the preferred intravenous drugs are labetalol and nicardipine.
If the preferred drugs cannot be used or do not work, sodium nitroprusside, hydralazine, and esmolol are other intravenous drugs that may be used.
Once blood pressure has been lowered, doctors can give children drugs by mouth (orally).
Children with a hypertensive urgency (severe hypertension but no symptoms and no organ problems) also are admitted to a hospital or emergency department and are evaluated immediately, but blood pressure does not need to be lowered as quickly as for a hypertensive emergency. These children are typically given drugs by mouth. Occasionally, intravenous drugs are needed.
For hypertensive urgencies, clonidine, hydralazine, isradipine, or minoxidil is given by mouth.
If possible, children with either disorder should be treated by a doctor or specialist experienced in managing severe high blood pressure in children.
