(See also High Blood Pressure in Children High Blood Pressure in Children High blood pressure (hypertension) is persistently high pressure in the arteries. Usually, high blood pressure in children, as in adults, has no identifiable cause. During childhood, most children... read more and High Blood Pressure High Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more in adults.)
Hypertensive emergencies occur when blood pressure rapidly increases.
In children, the first symptoms of a hypertensive emergency are typically a headache, listlessness, confusion, and seizures and, in infants, irritability.
Doctors diagnose hypertensive emergency by measuring blood pressure and doing tests for organ damage, such as electrocardiography, echocardiography, and blood and urine tests.
Treatment of hypertensive emergencies involves admitting children to an intensive care unit and giving drugs by vein to lower blood pressure as soon as possible.
When blood pressure is checked, two values are recorded. The higher value reflects the highest pressure in the arteries, which is reached when the heart contracts (during systole). The lower value reflects the lowest pressure in the arteries, which is reached just before the heart begins to contract again (during diastole). Blood pressure is written as systolic pressure/diastolic pressure—for example, 120/80 mm Hg (millimeters of mercury), referred to as 120 over 80.
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 Kidney Defects There are several different birth defects that affect the kidneys (the two organs that filter waste from the blood to make urine). These defects are not usually apparent at the doctor's examination... read more , bronchopulmonary dysplasia Bronchopulmonary Dysplasia (BPD) Bronchopulmonary dysplasia is a chronic lung disorder in newborns caused by extended use of a ventilator (a machine that helps air get in and out of the lungs) and/or extended need for supplemental... read more , coarctation of the aorta Coarctation of the Aorta Coarctation of the aorta is a narrowing of part of the aorta, the main blood vessel bringing red oxygenated blood from the heart to the body. The aorta narrows, causing the heart to pump harder... read more , renal vein thrombosis Renal Vein Thrombosis Renal vein thrombosis is blockage of the renal vein, which carries blood away from the kidney, by a blood clot. The clot can damage the kidney. Symptoms may be minimal unless the clot develops... read more , and other disorders that affect the blood vessels to the kidneys Overview of Blood Vessel Disorders of the Kidneys The blood flow to the kidneys needs to be intact for the kidneys to function properly. Any interruption of or reduction in the blood flow can cause kidney damage or dysfunction and, if long-standing... read more
During childhood: Kidney tissue disease, disorders that affect the blood vessels to the kidneys Overview of Blood Vessel Disorders of the Kidneys The blood flow to the kidneys needs to be intact for the kidneys to function properly. Any interruption of or reduction in the blood flow can cause kidney damage or dysfunction and, if long-standing... read more , 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 Anabolic Steroids Anabolic steroids are synthetic (man-made) versions of testosterone that are used to increase muscle size. Anabolic steroids are hormones that promote muscle growth and increase strength and... read more , 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
Eyes, which can result in papilledema (swelling of the optic nerve) and bleeding in the retina
If untreated, a hypertensive emergency can be fatal.
A hypertensive urgency is severe high blood pressure that has not yet caused enough organ damage to result in symptoms.
Symptoms of Hypertensive Emergencies in Children
Blood pressure is very high, typically at a stage 2 (severe) high blood pressure level or higher (140/90 or higher).
In children, the first symptoms of a hypertensive emergency are typically a headache, listlessness (lethargy), confusion, seizures, and, in infants, irritability. Children may go into a coma.
Children may have a rapid heart rate, chest pain, shortness of breath, and/or swollen ankles. Vision may be impaired.
Diagnosis of Hypertensive Emergencies in Children
Blood pressure measurement
Tests to evaluate organ damage
During a suspected hypertensive emergency, doctors use an oscillometer to measure blood pressure Diagnosis High blood pressure (hypertension) is persistently high pressure in the arteries. Usually, high blood pressure in children, as in adults, has no identifiable cause. During childhood, most children... read more rather than using a stethoscope. The oscillometer records blood pressure automatically and quickly, which helps with the measuring that is needed (every 2 to 3 minutes). Blood pressure is measured again using a sphygmomanometer Measuring Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Usually, high blood pressure in children, as in adults, has no identifiable cause. During childhood, most children... read more and a stethoscope to confirm the measurement. When possible, doctors do intra-arterial blood pressure monitoring, which involves putting a small plastic tube inside an artery and connecting it to a pressure monitor. These arterial pressure monitors measure blood pressure continuously and are also more accurate than other devices.
Doctors take a medical history Medical History The medical history and physical examination can suggest that a person has a heart or blood vessel disorder that requires additional testing for accurate diagnosis. When doctors "take a medical... read more , which includes questions about the child's current symptoms, any disorders the child has, and any drugs the child takes.
A thorough physical examination Physical Examination The medical history and physical examination can suggest that a person has a heart or blood vessel disorder that requires additional testing for accurate diagnosis. When doctors "take a medical... read more and standard blood and urine tests are done.
Tests are also done to determine whether vital organs are damaged and, if so, how much damage is present. Tests include
Electrocardiography (ECG), chest x-ray, and, if possible, an echocardiography to check for heart disorders
Urinalysis to screen for kidney abnormalities
Blood tests to check for kidney damage or hormonal abnormalities
Complete blood count to check for abnormal numbers of blood cells, particularly platelets (which help blood clot)
Computed tomography (CT) or magnetic resonance imaging (MRI) of the head to check for a mass or hemorrhage in the brain and to rule out other possible causes of symptoms related to the brain
Drug and pregnancy tests in adolescents
If the child's high blood pressure has not previously been diagnosed or evaluated, other testing to determine the cause of the high blood pressure Diagnosis High blood pressure (hypertension) is persistently high pressure in the arteries. Usually, high blood pressure in children, as in adults, has no identifiable cause. During childhood, most children... read more can be done later.
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 unit (ICU) Types of units People who need specific types of care may be put in special care units. Intensive care units (ICUs) are for people who are seriously ill. These people include those who have had a sudden, general... read more or, if an ICU is not available, to 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.