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

Points and Pearls Excerpt

• The younger a child is, the greater the likelihood that the child’s hypertension is a result of a pathology (secondary hypertension).
• Assume that any child aged < 6 years or any child with stage 2 hypertension has an underlying etiology that will need urgent evaluation.
• Younger children with hypertension often present with altered mental status and coma, compared with older children who often present with headache and dizziness.
• Ask about a history of prematurity and umbilical artery catheterizations, as both are known risk factors for hypertension.

Most Important References

• Flynn JT, Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol. 2009;24(6):1101-1112. (Review article) 
• Kaelber DC, Liu W, Ross M, et al. Diagnosis and medication treatment of pediatric hypertension: a retrospective cohort study. Pediatrics. 2016;138(6). (Retrospective cohort; 1.2 mil-lion pediatric patients)
• Yang W-C, Wu H-P. Clinical analysis of hypertension in children admitted to the emergency department. Pediatr Neonatol. 2010;51(1):44-51. (Retrospective review; 99 patients)
• Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3). (Clinical guidelines) 
• Wiesen J, Adkins M, Fortune S, et al. Evaluation of pediatric patients with mild-to-moderate hypertension: yield of diagnostic testing. Pediatrics. 2008;122(5):e988-e993. (Retrospective chart review; 249 patients)
• Chandar J, Zilleruelo G. Hypertensive crisis in children. Pediatr Nephrol. 2011;27(5):741-751. (Review article)
• Dionne JM, Flynn JT. Management of severe hypertension in the newborn. Arch Dis Child. 2017;102(12):1176-1179. (Review article)