Pediatric Hypertension and Hypertensive Emergencies: Recognition and Management in the Emergency Department
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Pediatric Hypertension and Hypertensive Emergencies: Recognition and Management in the Emergency Department -

Publication Date: March 2019 (Volume 16, Number 3)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAP Prescribed credits; and 4 AOA Category 2-A or 2-B CME credits. Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional approval. CME expires 03/01/2022. 


Emily MacNeill, MD
Associate Professor of Emergency Medicine, Carolinas Medical Center, Atrium Health, Charlotte, NC
Peer Reviewers
Richard M. Cantor, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics; Section Chief, Pediatric Emergency Medicine; Medical Director, Upstate Poison Control Center, Golisano Children’s Hospital, Syracuse, NY
Director for Pre-Health Undergraduate Education, Director of the Minor in Health Care Studies, Keck School of Medicine of the University of Southern California; Assistant Professor of Clinical Emergency Medicine, Los Angeles County + USC Medical Center, Los Angeles, CA

Pediatric hypertension is increasing in incidence, but remains greatly underrecognized, despite its severe long-term health consequences. Often discovered as incidental to another complaint, pediatric patients with hypertension may be asymptomatic but with markedly abnormal blood pressure, or they may have a true hypertensive emergency. This issue provides strategies to ensure that the child with asymptomatic hypertension receives appropriate screening and referrals, and outlines a systematic approach for the evaluation and treatment of the critically ill child who presents with symptoms of severe hypertension.

Excerpt From This Issue

A 5-year-old girl presents to the ED with a clavicle deformity after falling at the playground. You are almost ready to discharge her after confirmatory x-ray and sling placement when you note that her blood pressure is 150/90 mm Hg. Realizing that oscillometric devices may be inaccurate, you measure her blood pressure with a manual manometer, and it is 170/100 mm Hg. On further questioning, you learn that she has no significant medical history and no family history of hypertension. What defines hypertension in a child this age? Are additional tests needed? Do you need to treat this level of hypertension?

The following week, you are back in the ED when a medic calls ahead to say that they are on their way with a 16-year-old boy with altered mental status. She reports his vital signs, and you ask her to repeat the blood pressure, which she confirms is 140/80 mm Hg. You wonder whether this patient’s blood pressure is the cause of his altered mental status, or is there something else going on? Should you treat hypertension in this patient the same way you would in an adult? How aggressive do you need to be with lowering his blood pressure? Should you advise the medic to give medications prehospital prior to ED arrival?

Product Reviews
- 09/06/2019
I am better aware of the staged w/u for elevated bp, HTN w/o sx, HTN with sx.
- 09/05/2019
This was a particularly concise and well-written article.
- 09/04/2019
This was a particularly concise and well-written article.
- 09/03/2019
I’ll have more vigilant screening and proper management of HTN.
- 09/02/2019
I will be more aware of hypertension in peds... and make sure that we are getting accurate vitals because I'm sure that's mostly the issue where I work (not rechecking with manual cuffs) etc.
- 08/30/2019
This is such a good and valuable cme.
- 08/29/2019
I think I can more appropriately diagnose stage I versus stage II and III hypertension, and what measures to take appropriately.
- 08/27/2019
Increased awareness of pediatric hypertension with stronger referrals and possibly ER work up
- 08/07/2019
Will pay more attention to slightly elevated BP instead of blaming stress or pain in the ED.
- 08/05/2019
Very helpful. Thanks
- 08/01/2019
I will be more aware of BP elevations by age and stage, repeat manually if elevated, and recommend f/u with pcp. Will also add CBC to my usual electrolytes for better management.
Matthew K, MD - 04/26/2019
This was a particularly concise and well-written article.
Summer S, MD - 04/09/2019
This is such a good and valuable cme.
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