Abstract
Beginning with the definitions, this chapter will explore the pertinent information about Hypertensive Emergencies and Urgencies for the Pediatric Critical Care Physician. It provides an in depth review of the reliable ways to measure blood pressure in the PICU. Once sure of the blood pressure reading, the reader is then taught the normal renal, endothelial and cerebral controls over systemic blood pressure as a way to understand the pathophysiology behind hypertension. The most common pediatric etiologies and appropriate diagnostic testing are then outlined in the context of the clinical presentations of hypertensive emergency. Lastly, the medications used in hypertensive emergency are then presented by class and a table of available continuous infusions provides an easy reference guide for the critical care physician.
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References
Falkner B. Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol. 2010;25:1219–24.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Rocella EJ, The National High Blood Pressure Education Program Coordinating Committee. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.
Marik PE, Varon P. Hypertensive crises: challenges and management. Chest. 2007;131:1949–62.
Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wuhl E, Zancehtti A. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens. 2009;27:1719–42.
Calhoun DA, Oparil S. Treatment of hypertensive crisis. N Engl J Med. 1990;323:1177–83.
Houston MC. Pathophysiology, clinical aspects, and treatment of hypertensive crisis. Prog Cardiovasc Dis. 1989;32:99–148.
Patel HP, Mitsnefes M. Advances in the pathogenesis and management of hypertensive crisis. Curr Opin Pediatr. 2005;17:210–4.
Flynn JT, Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol. 2009;24:1101–12.
Haas AR, Marik PE. Current diagnosis and management of hypertensive emergency. Sem Dialysis. 2006;19(6):502–12.
Carr JJ, Brown JM. Introduction to biomedical equipment technology. 2nd ed. Englewood Cliffs: Regents/Prentice Hall; 1993. p. 163–73.
Bagga A, Jain R, Vijayakumar M, Kanitkar M, Ali U. Evaluation and management of hypertension. Indian Pediatr. 2007;44:103–21.
Perloff WH. Invasive measurements in the PICU. In: Fuhrman BP, Zimmerman JJ, editors. Pediatric critical care. St. Louis: Mosby; 1992. p. 67–98.
Blumenfeld JD. Renal and cardiac complications of hypertension. Clin Symp. 1994;46:1–32.
Grinsell MM, Norwood VF. At the bottom of the differential diagnosis list: unusual cases of pediatric hypertension. Pediatr Nephrol. 2009;24:2137–46.
Plouin PF, Gimenez-Roqueplo AP. Pheochromocytomas and secreting paragangliomas. Orphanet J Rare Dis. 2006;1:49.
Vallance P, Collier J. Biology and clinical relevance of nitric oxide. BMJ. 1994;309:453–7.
Luscher TF. Endothelin, endothelin receptors, and endothelin antagonists. Curr Opin Nephrol Hypertens. 1994;3:92–8.
Moore R, Linas S. Endothelian antagonists and resistant hypertension in chronic kidney disease. Curr Opin Nephrol Hypertens. 2010;19(5):432–6.
Gardner CJ, Lee K. Hyperperfusion syndromes: insight into the pathophysiology and treatment of hypertensive encephalopathy. CNS Spectr. 2007;12(1):35–42.
Reed G, Devous M. Southwestern internal medicine conference: cerebral blood flow autoregulation and hypertension. Am J Med Sci. 1985;289:37–44.
Sandok BA, Whisnant JP. Hypertension and the brain. Arch Intern Med. 1974;133:947–54.
Tietjen CS, Hurn PD, Ulatowski JA, Kirsch JR. Treatment modalities for hypertensive patients with intracranial pathology: options and risks. Crit Care Med. 1996;24:311–22.
Johansson B, Strandgaard S, Lassen NA. On the pathogenesis of hypertensive encephalopathy: the hypertensive “breakthrough” of autoregulation of cerebral blood flow with forced vasodilatation, flow increase, and blood–brain-barrier damage. Circ Res. 1974;34/35 Suppl 1:167–71.
Ogoh S, Nakahra H, Ainslie PN, Miyamoto T. The effect of oxygen on dynamic cerebral autoregulation: critical role of hypocapnia. J Appl Physiol. 2010;108:538–43.
Viera AJ, Neutze DM. Diagnosis of secondary hypertension: an age-based approach. Am Fam Physician. 2010;82(12):1471–8.
Chiolero A, Bovet P, Paradis G, Paccaud F. Has blood pressure increased in children in response to the obesity epidemic? Pediatrics. 2007;119:544–53.
Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B, Mietus-Snyder ML. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2009;119:6238–647.
Fugate JE, Classen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiographic findings. Mayo Clin Proc. 2010;85(5):427–32.
Doelken M, Lanz S, Rennert J, Alibek S, Richter G. Doerfler. Differentiation of cytotoxic and vasogenic edema in a patient with reversible posterior leukoencephalopathy syndrome using diffusion-weighted MRI. Diagn Interv Radiol. 2007;13:125–8.
Bartynski WS. Posterior Reversible Encephalopathy Syndrome, Part 1: fundamental imaging and clinical features. Am J Neuroradiol. 2008;29:1036–42.
Peacock F, Amin A, Granger CB, Pollack CV, Levy P, Nowak R, Kleinschmidt K, Varon J, Wyman A, Gore JM. Hypertensive heart failure: patient characteristics, treatment and outcomes. Am J Emerg Med. 2011;29(8):855–62.
Bak RS. Nitroprusside. Am Assoc Clin Chem TDM/Tox. 1992;13:9–13.
Crabbe SJ. Sodium thiosulfate/sodium nitroprusside infusion to prevent cyanide toxicity. P&T. 1991;576:581.
Zerbe NF, Wagner BKJ. Use of vitamin B12 in the treatment and prevention of nitroprusside-induced cyanide toxicity. Crit Care Med. 1993;21:465–7.
Gidding SS, Rocchini AP, Beekman R, Szpunar CA, Moorehead C, Behrendt D, Rosenthal A. Therapeutic effect of propranolol on paradoxical hypertension after repair of coarctation of the aorta. N Engl J Med. 1985;312:1224–8.
Sinaiko AR. Pharmacologic management of childhood hypertension. Pediatr Clin North Am. 1993;40:195–212.
Luft FC, Mann JFE. New classes of antihypertensive drugs and new findings with established agents. Curr Opin Nephrol Hypertens. 1992;1:91–9.
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Hassinger, A.B., Goodman, D.M. (2014). Hypertensive Emergencies. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6356-5_32
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DOI: https://doi.org/10.1007/978-1-4471-6356-5_32
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