The Evidence-Based Emergency Management Of Pediatric Hypertension

Cico, Stephen MD, FAAEM, FAAP
Black, Kelly MD, MSc, FAAP
Caglar, Derya MD, FAAP
Reviewers, Peer
Bradin, Stuart MD, FAAP
Oishi, Peter MD, MS

Assistant Professor of Pediatrics, Associate Fellowship Director of Pediatric Emergency Medicine, University of Washington; Attending Physician, Division of Emergency Medicine, Seattle Children's Hospital, Seattle, WA
Assistant Professor of Pediatrics, University of Washington; Attending Physician, Division of Emergency Medicine, Seattle Children's Hospital, Seattle, WA
Assistant Professor of Pediatrics, University of Washington; Attending Physician, Division of Emergency Medicine, Seattle Children's Hospital, Seattle, WA
Assistant Professor of Pediatrics and Emergency Medicine, Attending Physician, Children's Emergency Services, The University of Michigan Health System, Ann Arbor, MI
Assistant Professor of Pediatrics, Associate Investigator, Cardiovascular Research Institute, University of California San Francisco; Director of Critical Care Quality, Patient Safety and Program Initiatives, Benioff Children's Hospital, San Francisco, CA

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Pediatric Emergency Medicine Practice 9(4):p 1-20, April 2012.

Abstract

The incidence of pediatric hypertension is rising. Though primary hypertension is seen in children, secondary causes of hypertension are more common, including renal (most common), vascular, endocrine, pharmacologic, psychosocial, and neurologic etiologies. This review emphasizes that emergency department clinicians should document blood pressures and consider common causes of pediatric hypertension. Once a hypertensive crisis has been excluded, much of the work-up for a pediatric patient who presents with hypertension can be done as an outpatient by their primary care provider. Though rare in pediatrics, hypertensive crises must be quickly recognized and treated. Once airway, breathing, and circulation have been stabilized, intravenous antihypertensives should be used to treat hypertensive emergencies, and patients should be admitted for close observation, evaluation, and treatment until good control has been achieved. Hypertensive urgencies can often be treated with oral agents. Both forms of hypertensive crisis warrant a limited work-up in the emergency department.