2. 1EMERGENCY= Severe SYMPTOMATIC elevation in
BP WITH evidence of end organ damage
Brain (seizures, increased ICP)
Kidneys (renal insufficiency)
Eyes (papilledema, retinal hemorrhage, exudates)
Heart (heart failure)
URGENCY= Severe elevation in BP WITHOUT severe
symptoms or evidence of end organ damage
Definitions
3. 2 Most common type of hypertensive emergency
Severe BP elevation with cerebral edema +
neurological sx of lethargy and/or seizures
Pathophysiology: cerebrovascular endothelium
breaks down secondary to failure of
cerebral autoregulation
AMS/seizures occurred in 50% of 110 patients
in one retrospective series*. 27% had
hypertensive retinopathy and 13% had LV
hypertrophy
Hypertensive encephalopathy
*Deal JE et al. Arch Dis Child. 1992
5. 4
Approach
Confirm marked BP elevation
Rapid assessment of severity of disease
Exclusion of other causes of severe HTN
for which rapid reduction of BP might be harmful
(intracranial injury, mass lesion, coarct, drugs)
Emergent antihypertensive therapy
6. 5
Management
No large clinical trials evaluating management of HTN emergencies
in kids
Goal: lower BP promptly by no more than 25% within 8 hours of
treatment
For HTN emergency: bolus dose IV hydralazine or labetolol followed
by nicardipine or labetolol ggt
