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Published in: Current Hypertension Reports 3/2024

17-11-2023 | Hypertension | Hypertension and Emergency Medicine (J Miller, Section Editor)

Evaluation and Management of Elevated BP in Children in the ED

Authors: Lilian Awad, Usha Sethuraman

Published in: Current Hypertension Reports | Issue 3/2024

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Abstract

Purpose of Review

Pediatric hypertension has been on the rise over the past four decades. While most cases are evaluated and managed in the primary healthcare setting, some children may be referred to the emergency department (ED) for an expedited workup of elevated blood pressure or for management of hypertensive crisis.

Recent Findings

Acute severe hypertension without end-organ damage and hypertensive emergency are life-threatening conditions that healthcare providers must be prepared to accurately recognize and treat as pediatric hypertension increases in prevalence.

Summary

In this article, we review the most recent definitions of elevated blood pressure and hypertension and discuss the updated literature on the evaluation and management of hypertension and hypertensive crisis of children in the ED.
Literature
3.
go back to reference Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, et al. Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement From the American Heart Association. Hypertension. 2023;80(6):e101-e111. https://doi.org/10.1161/HYP.0000000000000228. Epub 2023 Mar 30. PMID: 36994715. Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, et al. Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement From the American Heart Association. Hypertension. 2023;80(6):e101-e111. https://​doi.​org/​10.​1161/​HYP.​0000000000000228​. Epub 2023 Mar 30. PMID: 36994715.
4.
go back to reference Flynn JT, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents, (in eng). Pediatrics. 2017;140(3). https://doi.org/10.1542/peds.2017-1904. 2017 American Academy of Pediatrics Clinical Practice Guidelines for the screening and management of pediatric hypertension at clinic visit. Flynn JT, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents, (in eng). Pediatrics. 2017;140(3). https://​doi.​org/​10.​1542/​peds.​2017-1904. 2017 American Academy of Pediatrics Clinical Practice Guidelines for the screening and management of pediatric hypertension at clinic visit.
11.
go back to reference • Bertazza Partigiani N, Spagnol R, Di Michele L, Santini M, Grotto B, Sartori A, et al. management of hypertensive crises in children: a review of the recent literature. Front Pediatr. 2022;15(10):880678. https://doi.org/10.3389/fped.2022.880678.PMID:35498798;PMCID:PMC9051430. A meta-analysis and systematic review of hypertensive crisis in pediatrics that reviews the most common etiologies and suggests that beta-blockers and calcium channel blockers are effective and safe in hypertensive crisis.CrossRef • Bertazza Partigiani N, Spagnol R, Di Michele L, Santini M, Grotto B, Sartori A, et al. management of hypertensive crises in children: a review of the recent literature. Front Pediatr. 2022;15(10):880678. https://​doi.​org/​10.​3389/​fped.​2022.​880678.​PMID:​35498798;PMCID:​PMC9051430. A meta-analysis and systematic review of hypertensive crisis in pediatrics that reviews the most common etiologies and suggests that beta-blockers and calcium channel blockers are effective and safe in hypertensive crisis.CrossRef
13.
go back to reference Mattoo TK. Evaluation of hypertension in children and adolescents. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023. Mattoo TK. Evaluation of hypertension in children and adolescents. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023.
18.
go back to reference Mattoo TK. Epidemiology, risk factors, and etiology of hypertension in children and adolescents. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023. Mattoo TK. Epidemiology, risk factors, and etiology of hypertension in children and adolescents. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023.
19.
go back to reference Uspal NG, Halbach SM. Approach to hypertensive emergencies and urgencies in children. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023. Uspal NG, Halbach SM. Approach to hypertensive emergencies and urgencies in children. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023.
20.
go back to reference Kaelber DC, Localio AR, Ross M, Leon JB, Pace WD, Wasserman RC, et al. Persistent hypertension in children and adolescents: a 6-year cohort study. Pediatrics. 2020;146(4):e20193778. https://doi.org/10.1542/peds.2019-3778. Epub 2020 Sep 18. PMID: 32948657; PMCID: PMC7786824. Kaelber DC, Localio AR, Ross M, Leon JB, Pace WD, Wasserman RC, et al. Persistent hypertension in children and adolescents: a 6-year cohort study. Pediatrics. 2020;146(4):e20193778. https://​doi.​org/​10.​1542/​peds.​2019-3778. Epub 2020 Sep 18. PMID: 32948657; PMCID: PMC7786824.
22.
go back to reference Shaw KN, Fleisher GR, Ludwig S, Genisca AE, Merritt C. Hypertension. In Fleisher & Ludwig’s textbook of pediatric emergency medicine (pp. 240–247). essay, Wolters Kluwer. 2021. Shaw KN, Fleisher GR, Ludwig S, Genisca AE, Merritt C. Hypertension. In Fleisher & Ludwig’s textbook of pediatric emergency medicine (pp. 240–247). essay, Wolters Kluwer. 2021.
23.
go back to reference Mattoo TK. Definition and diagnosis of hypertension in children and adolescents. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023. Mattoo TK. Definition and diagnosis of hypertension in children and adolescents. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023.
25.
go back to reference Hoffman RJ, Wang VJ, Scarfone R, Godambe S, Nagler J. Hypertension, hypertensive crisis. In Fleisher & Ludwig’s 5-minute pediatric emergency medicine consult (pp. 446–447). essay, Wolters Kluwer. 2021. Hoffman RJ, Wang VJ, Scarfone R, Godambe S, Nagler J. Hypertension, hypertensive crisis. In Fleisher & Ludwig’s 5-minute pediatric emergency medicine consult (pp. 446–447). essay, Wolters Kluwer. 2021.
26.
go back to reference Flynn JT. Initial management of hypertensive emergencies and urgencies in children. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023. Flynn JT. Initial management of hypertensive emergencies and urgencies in children. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2023.
27.
go back to reference Lim AM, Chong SL, Ng YH, Chan YH, Lee JH. Epidemiology and management of children with hypertensive crisis: a single-center experience. J Pediatr Intensive Care. 2020;9(1):45–50. https://doi.org/10.1055/s-0039-1698759. Epub 2019 PMID:31984157; PMCID:PMC6978164. Lim AM, Chong SL, Ng YH, Chan YH, Lee JH. Epidemiology and management of children with hypertensive crisis: a single-center experience. J Pediatr Intensive Care. 2020;9(1):45–50. https://​doi.​org/​10.​1055/​s-0039-1698759. Epub 2019 PMID:31984157; PMCID:PMC6978164.
28.
go back to reference • Lad S, Patil M, Jayashree M, et al. Efficacy and safety of intravenous labetalol in acute hypertensive crisis in children. Indian J Pediatr. 2022;89:7–12. https://doi.org/10.1007/s12098-021-03707-7. This article suggests that children admitted to an intensive care unit with hypertensive emergency who received labetalol either as single therapy or with another anti-hypertensive were more likely to reach their goal BP and had improved neurological outcomes.CrossRefPubMed • Lad S, Patil M, Jayashree M, et al. Efficacy and safety of intravenous labetalol in acute hypertensive crisis in children. Indian J Pediatr. 2022;89:7–12. https://​doi.​org/​10.​1007/​s12098-021-03707-7. This article suggests that children admitted to an intensive care unit with hypertensive emergency who received labetalol either as single therapy or with another anti-hypertensive were more likely to reach their goal BP and had improved neurological outcomes.CrossRefPubMed
Metadata
Title
Evaluation and Management of Elevated BP in Children in the ED
Authors
Lilian Awad
Usha Sethuraman
Publication date
17-11-2023
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 3/2024
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-023-01283-z
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