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World J Clin Cases. Jun 16, 2015; 3(6): 510-513
Published online Jun 16, 2015. doi: 10.12998/wjcc.v3.i6.510
Clinical overview of hypertensive crisis in children
Wen-Chieh Yang, Mao-Jen Lin, Chun-Yu Chen, Han-Ping Wu
Wen-Chieh Yang, Chun-Yu Chen, Division of Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua 500, Taiwan
Wen-Chieh Yang, Chun-Yu Chen, School of Medicine, Chung Shan Medical University, Taichung 400, Taiwan
Mao-Jen Lin, Division of Cardiology, Department of Medicine, Taichung Tzuchi Hospital, the Buddhist Medical Foundation, Taichung 400, Taiwan
Mao-Jen Lin, Institute of Medicine, Chung Shan Medical University, Taichung 400, Taiwan
Mao-Jen Lin, Han-Ping Wu, Department of Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
Han-Ping Wu, Department of Pediatrics, Taichung Tzuchi Hospital, the Buddhist Medical Foundation, Taichung 400, Taiwan
Author contributions: Yang WC and Lin MJ compared related studies, wrote the manuscript and contributed equally to this work; Chen CY coordinated, provided the collection of clinical images and wrote some parts of the manuscript; Wu HP designed the mini review.
Conflict-of-interest: There is no conflict of interest in the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Han-Ping Wu, MD, PhD, Department of Pediatrics, Taichung Tzuchi Hospital, the Buddhist Medical Foundation, No.88, Sec. 1, Fongsing Rd., Taichung 42743, Taiwan. arthur1226@gmail.com
Telephone: +886-4-36060666Fax: +886-4-36021123
Received: June 24, 2014
Peer-review started: June 25, 2014
First decision: August 14, 2014
Revised: February 15, 2015
Accepted: March 16, 2015
Article in press: March 18 2015
Published online: June 16, 2015
Abstract

Hypertensive emergencies and hypertensive urgencies in children are uncommonly encountered in the pediatric emergency department and intensive care units, but the diseases are potentially a life-threatening medical emergency. In comparison with adults, hypertension in children is mostly asymptomatic and most have no history of hypertension. Additionally, measuring accurate blood pressure values in younger children is not easy. This article reviews current concepts in pediatric patients with severe hypertension.

Keywords: Hypertensive crisis, Hypertensive urgency, Hypertensive emergency, Blood pressure

Core tip: Hypertensive crisis in children is a disease easily mismanaged in the emergency department. The physician should carefully search for evidence of end organ injury to distinguish between hypertensive emergency and hypertensive urgency. Only patients with hypertensive emergency require immediate reduction in markedly elevated blood pressure to prevent and arrest progressive end organ damage. In all other patients, the elevated blood pressure can be lowered slowly using oral agents, i.e., esmolol, nicardipine, labetalol and fenoldopam. All young children should receive complete examinations to look for the underlying cause of secondary hypertension.