Abstract
Hypertensive crisis can be a source of morbidity and mortality in the pediatric population. While the epidemiology has been difficult to pinpoint, it is well-known that secondary causes of pediatric hypertension contribute to a greater incidence of hypertensive crisis in pediatrics. Hypertensive crisis may manifest with non-specific symptoms as well as distinct and acute symptoms in the presence of end-organ damage. Hypertensive emergency, the form of hypertensive crisis with end-organ damage, may present with more severe symptoms and lead to permanent organ damage. Thus, it is crucial to evaluate any pediatric patient suspected of hypertensive emergency with a thorough workup while acutely treating the elevated blood pressure in a gradual manner. Management of hypertensive crisis is chosen based on the presence of end-organ damage and can range from fast-acting intravenous medication to oral medication for less severe cases. Treatment of such demands a careful balance between decreasing blood pressure in a gradual manner while preventing damage end-organ damage. In special situations, protocols have been established for treatment of hypertensive crisis, such as in the presence of endocrinologic neoplasms, monogenic causes of hypertension, renal diseases, and cardiac disease. With the advent of telehealth, clinicians are further able to extend their reach of care to emergency settings and aid emergency medical service (EMS) providers in real time. In addition, further updates on the evolving topic of hypertension in the pediatric population and novel drug development continues to improve outcomes and efficiency in diagnosis and management of hypertension and consequent hypertensive crisis.
Highlights
Hypertensive crisis can be a source of great harm to the pediatric population
While there are no specific cutoffs in terms of blood pressure for hypertensive crisis in pediatric patients (Table 1), as there are in the adult population, hypertensive crisis is primarily a clinical diagnosis which should be suspected in any pediatric patient with blood pressure at or exceeding the limits of stage II hypertension
Identifying hypertensive crisis can be challenging as patients may present with non-specific symptoms that may be difficult to distinguish from other common illnesses
Summary
Hypertensive crisis can be a source of great harm to the pediatric population. With its potential for rapidly progressing end-organ damage, hypertensive crisis should be promptly identified and concomitantly treated. Hypertensive crisis is defined as an acute episode of severely elevated blood pressure with potential for end-organ damage, often exceeding the limits known for stage II. The management of patients suspected of being in hypertensive crisis revolves around decreasing blood pressure in the acute setting while identifying and treating the underlying cause in order to prevent organ damage from occurring [10,11,12,13,14]. In the absence of hypertensive emergency or signs and symptoms of end-organ damage, these patients will present unique diagnostic challenges and highlight the importance of obtaining a full workup in those suspected of hypertensive crisis. When considering the diagnosis of hypertensive crisis, it is of utmost importance to measure blood pressure in Frontiers in Pediatrics | www.frontiersin.org
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