Limits...
Hypertensive crisis in children: an experience in a single tertiary care center in Korea.

Lee GH, Lee IR, Park SJ, Kim JH, Oh JY, Shin JI - Clin Hypertens (2016)

Bottom Line: Baseline etiologies and risk factors were compared between the two groups.However, it was often ineffective for controlling abrupt elevated blood pressure.Furthermore, both nicardipine and labetalol may be effective antihypertensive drug in lowering high blood pressure in children with hypertensive crisis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Hypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea.

Methods: We analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs.

Results: Kidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration.

Conclusion: Close blood pressure monitoring and careful examinations should be mandatory in children with underlying disease, especially renal diseases and cancer. Furthermore, both nicardipine and labetalol may be effective antihypertensive drug in lowering high blood pressure in children with hypertensive crisis.

No MeSH data available.


Related in: MedlinePlus

Changes in systolic (a) and diastolic (b) blood pressure by administration of labetalol and nicardipine during 5 hours
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4834822&req=5

Fig1: Changes in systolic (a) and diastolic (b) blood pressure by administration of labetalol and nicardipine during 5 hours

Mentions: In both hypertensive emergency and hypertensive urgency group, there was no significant difference in reduction of SBP and DBP between nicardipine and labetalol administration (Table 5). However, nicardipine showed more decreased SBP at 4 hours than labetalol, although it had a borderline significance (Fig. 1).Table 5


Hypertensive crisis in children: an experience in a single tertiary care center in Korea.

Lee GH, Lee IR, Park SJ, Kim JH, Oh JY, Shin JI - Clin Hypertens (2016)

Changes in systolic (a) and diastolic (b) blood pressure by administration of labetalol and nicardipine during 5 hours
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4834822&req=5

Fig1: Changes in systolic (a) and diastolic (b) blood pressure by administration of labetalol and nicardipine during 5 hours
Mentions: In both hypertensive emergency and hypertensive urgency group, there was no significant difference in reduction of SBP and DBP between nicardipine and labetalol administration (Table 5). However, nicardipine showed more decreased SBP at 4 hours than labetalol, although it had a borderline significance (Fig. 1).Table 5

Bottom Line: Baseline etiologies and risk factors were compared between the two groups.However, it was often ineffective for controlling abrupt elevated blood pressure.Furthermore, both nicardipine and labetalol may be effective antihypertensive drug in lowering high blood pressure in children with hypertensive crisis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Background: Hypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea.

Methods: We analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs.

Results: Kidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration.

Conclusion: Close blood pressure monitoring and careful examinations should be mandatory in children with underlying disease, especially renal diseases and cancer. Furthermore, both nicardipine and labetalol may be effective antihypertensive drug in lowering high blood pressure in children with hypertensive crisis.

No MeSH data available.


Related in: MedlinePlus