What are the treatment approaches to pediatric hypertension?

Updated: Feb 05, 2018
  • Author: Christy Hopkins, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

In pediatric hypertension, in the absence of hypertensive target organ damage, diet and exercise are used to treat stage I hypertension, followed by the addition of drug therapy if the initial strategy is unsuccessful. [17] In the presence of stage I hypertension with end-organ damage and stage II hypertension, management includes lifestyle changes and pharmacotherapy with angiotensin-converting enzyme inhibitors (ACEIs), calcium-channel blockers (CCBs), or thiazide diuretics. Hypertensive emergency with end-organ effects requires immediate, modest BP reduction with cardiac class IV medications. [17] Gradual lowering of the BP is crucial to preventing cerebral ischemia as a result of autoregulatory mechanisms. [18]

A retrospective study of 13 children aged 2 months to 16 years in a pediatric intensive care unit (PICU) found that an infusion of metoprolol is safe and effective for a hypertensive emergency in this population. [19] The symptomatic children all had an initial BP of 23-75 mm Hg above the 99th percentile for their age, height, and sex at presentation and received metoprolol infusion at a dose of 1-5 mcg/kg/min. At 1, 8, and 24 hours, mean BP fell by an average of 12.3%, 20.4%, and 27.1%, respectively; heart rate did not fall below the normal range for age, and no significant metoprolol infusion adverse effects were noted, including no neurologic sequelae as a consequence of their hypertension. [19]


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