Management of Hypertensive Emergencies

  • Craig W. BelshaEmail author
Reference work entry


Severe, symptomatic hypertension occurs infrequently in childhood but when present often signifies a life-threatening emergency. The clinician needs to approach this situation with a sense of urgency to reduce blood pressure (BP) and limit end-organ damage while avoiding overly aggressive therapy, which may also lead to ischemia and further injury. This chapter discusses the causes, pathophysiology, evaluation, and treatment of severe hypertension.


Hypertensive Emergencies Hypertensive urgencies Severe hypertension Posterior reversible leukoencephalopathy syndrome Cerebral autoregulation 



Blood pressure


Joint National Committee.




Posterior reversible leukoencephalopathy syndrome.




  1. Adamson PC, Rhodes LA, Saul JP, Dick M, Epstein MR, Moate P, Boston R, Schreiner MS (2006) The pharmacokinetics of esmolol in pediatric subjects with supraventricular arrhythmias. Pediatr Cardiol 27(4):420–427PubMedGoogle Scholar
  2. Adelman RD, Coppo R, Dillon MJ (2000) The emergency management of severe hypertension. Pediatr Nephrol 14(5):422–427Google Scholar
  3. Baaske DM, DeMay JF, Latona CA, Mirmira S, Sigvardson KW (1996) Stability of nicardipine hydrochloride in intravenous solutions. Am J Health-Syst Pharm 53(14):1701–1705PubMedGoogle Scholar
  4. Baracco R, Mattoo TK (2014) Pediatric hypertensive emergencies. Curr Hypertens Rep 16(8):456PubMedGoogle Scholar
  5. Belsha CW (2008) Pediatric hypertension in the emergency department. Ann Emerg Med 51(3 Suppl):S21–S23PubMedGoogle Scholar
  6. Bender SR, Fong MW, Heitz S, Bisognano JD (2006) Characteristics and management of patients presenting to the emergency department with hypertensive urgency. J Clin Hypertens (Greenwich) 8(1):12–18Google Scholar
  7. Blaszak RT, Savage JA, Ellis EN (2001) The use of short-acting nifedipine in pediatric patients with hypertension. J Pediatr 139(1):34–37PubMedGoogle Scholar
  8. Browning AC, Mengher LS, Gregson RM, Amoaku WM (2001) Visual outcome of malignant hypertension in young people. Arch Dis Child 85(5):401–403PubMedPubMedCentralGoogle Scholar
  9. Bunchman TE, Lynch RE, Wood EG (1992) Intravenously administered labetalol for treatment of hypertension in children. J Pediatr 120(1):140–144PubMedGoogle Scholar
  10. Calvetta A, Martino S, von Vigier RO, Schmidtko J, Fossali E, Bianchetti MG (2003) What goes up must immediately come down! which indication for short-acting nifedipine in children with arterial hypertension? Pediatr Nephrol 18(1):1–2Google Scholar
  11. Castaneda MP, Walsh CA, Woroniecki RP, Del Rio M, Flynn JT (2005) Ventricular arrhythmia following short-acting nifedipine administration. Pediatr Nephrol 20(7):1000–1002PubMedGoogle Scholar
  12. Chandar J, Zilleruelo G (2012) Hypertensive crisis in children. Pediatr Nephrol 27(5):741–751PubMedGoogle Scholar
  13. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ (2003) Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42(6):1206–1252Google Scholar
  14. Constantine E, Linakis J (2005) The assessment and management of hypertensive emergencies and urgencies in children. Pediatr Emerg Care 21(6):391–396. quiz 397PubMedGoogle Scholar
  15. Cremer A, Amraoui F, Lip GY, Morales E, Rubin S, Segura J, Van den Born BJ, Gosse P (2016) From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency. J Hum Hypertens 30(8):463–466PubMedGoogle Scholar
  16. Croix B, Feig DI (2006) Childhood hypertension is not a silent disease. Pediatr Nephrol 21(4):527–532Google Scholar
  17. Curran MP, Robinson DM, Keating GM (2006) Intravenous nicardipine: its use in the short-term treatment of hypertension and various other indications. Drugs 66(13):1755–1782PubMedGoogle Scholar
  18. Daniels SR, Loggie JM, McEnery PT, Towbin RB (1987) Clinical spectrum of intrinsic renovascular hypertension in children. Pediatrics 80(5):698–704PubMedPubMedCentralGoogle Scholar
  19. Deal JE, Barratt TM, Dillon MJ (1992a) Management of hypertensive emergencies. Arch Dis Child 67(9):1089–1092PubMedPubMedCentralGoogle Scholar
  20. Deal JE, Snell MF, Barratt TM, Dillon MJ (1992b) Renovascular disease in childhood. J Pediatr 121(3):378–384PubMedPubMedCentralGoogle Scholar
  21. Deeks ED, Keating GM, Keam SJ (2009) Clevidipine: a review of its use in the management of acute hypertension. Am J Cardiovasc Drugs 9(2):117–134PubMedGoogle Scholar
  22. Egger DW, Deming DD, Hamada N, Perkin RM, Sahney S (2002) Evaluation of the safety of short-acting nifedipine in children with hypertension. Pediatr Nephrol 17(1):35–40PubMedGoogle Scholar
  23. Falkner B, Onesti G, Lowenthal DT, Affrime MB (1983) The use of clonidine monotherapy in adolescent hypertension. Chest 83(2 Suppl):425–427PubMedGoogle Scholar
  24. Falkner B, Thanki B, Lowenthal DT (1985) Transdermal clonidine in the treatment of adolescent hypertension. J Hypertens Suppl 3(4):S61–S63PubMedGoogle Scholar
  25. Farine M, Arbus GS (1989) Management of hypertensive emergencies in children. Pediatr Emerg Care 5(1):51–55PubMedGoogle Scholar
  26. Fivush B, Neu A, Furth S (1997) Acute hypertensive crises in children: emergencies and urgencies. Curr Opin Pediatr 9(3):233–236PubMedGoogle Scholar
  27. Flynn JT (2003) Safety of short-acting nifedipine in children with severe hypertension. Expert Opin Drug Saf 2(2):133–139PubMedGoogle Scholar
  28. Flynn JT, Bradford MC, Harvey EM (2016) Intravenous hydralazine in hospitalized children and adolescents with hypertension. J Pediatr 168:88–92PubMedGoogle Scholar
  29. Flynn JT, Kaelber DC, Baker-Smith CM et al. (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140(3):e20171904Google Scholar
  30. Flynn JT, Pasko DA (2000) Calcium channel blockers: pharmacology and place in therapy of pediatric hypertension. Pediatr Nephrol 15(3–4):302–316PubMedPubMedCentralGoogle Scholar
  31. Flynn JT, Tullus K (2009) Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol 24(6):1101–1112Google Scholar
  32. Flynn JT, Warnick SJ (2002) Isradipine treatment of hypertension in children: a single-center experience. Pediatr Nephrol 17(9):748–753PubMedPubMedCentralGoogle Scholar
  33. Fossali E, Signorini E, Intermite RC, Casalini E, Lovaria A, Maninetti MM, Rossi LN (2000) Renovascular disease and hypertension in children with neurofibromatosis. Pediatr Nephrol 14(8–9):806–810PubMedGoogle Scholar
  34. Fyfe KL, Yiallourou SR, Wong FY, Horne RS (2014) The development of cardiovascular and cerebral vascular control in preterm infants. Sleep Med Rev 18(4):299–310PubMedGoogle Scholar
  35. Gardner CJ, Lee K (2007) Hyperperfusion syndromes: insight into the pathophysiology and treatment of hypertensive encephalopathy. CNS Spectr 12(1):35–42PubMedGoogle Scholar
  36. Geyskes GG, Boer P, Dorhout Mees EJ (1979) Clonidine withdrawal. mechanism and frequency of rebound hypertension. Br J Clin Pharmacol 7(1):55–62PubMedPubMedCentralGoogle Scholar
  37. Goa KL, Benfield P, Sorkin EM (1989) Labetalol. a reappraisal of its pharmacology, pharmacokinetics and therapeutic use in hypertension and ischaemic heart disease. Drugs 37(5):583–627PubMedGoogle Scholar
  38. Gordillo-Paniagua G, Velásquez-Jones L, Martini R, Valdez-Bolaños E (1975) Sodium nitroprusside treatment of severe arterial hypertension in children. J Pediatr 87(5):799–802PubMedGoogle Scholar
  39. Gouyon JB, Geneste B, Semama DS, Françoise M, Germain JF (1997) Intravenous nicardipine in hypertensive preterm infants. Arch Dis Child Fetal Neonatal Ed 76(2):F126–F127PubMedPubMedCentralGoogle Scholar
  40. Grinsell MM, Norwood VF (2009) At the bottom of the differential diagnosis list: unusual causes of pediatric hypertension. Pediatr Nephrol 24(11):2137–2146.PubMedGoogle Scholar
  41. Groshong T (1996) Hypertensive crisis in children. Pediatr Ann 25(7):368–371. 375–366PubMedGoogle Scholar
  42. Hammer GB, Lewandowski A, Drover DR, Rosen DA, Cohane C, Anand R, Mitchell J, Reece T, Schulman SR (2015) Safety and efficacy of sodium nitroprusside during prolonged infusion in pediatric patients. Pediatr Crit Care Med 16(5):397–403PubMedGoogle Scholar
  43. Hammer GB, Verghese ST, Drover DR, Yaster M, Tobin JR (2008) Pharmacokinetics and pharmacodynamics of fenoldopam mesylate for blood pressure control in pediatric patients. BMC Anesthesiol 8:6PubMedPubMedCentralGoogle Scholar
  44. Harms MM, Rotteveel JJ, Kar NC, Gabreëls FJ (2000) Recurrent alternating facial paralysis and malignant hypertension. Neuropediatrics 31(6):318–320PubMedGoogle Scholar
  45. Holt TR, Withington DE, Mitchell E (2011) Which pressure to believe? A comparison of direct arterial with indirect blood pressure measurement techniques in the pediatric intensive care unit. Pediatr Crit Care Med 12(6):e391–e394PubMedGoogle Scholar
  46. Hooper DK, Carle AC, Schuchter J, Goebel J (2011) Interaction between tacrolimus and intravenous nicardipine in the treatment of post-kidney transplant hypertension at pediatric hospitals. Pediatr Transplant 15(1):88–95PubMedGoogle Scholar
  47. Houston MC (1986) Treatment of hypertensive emergencies and urgencies with oral clonidine loading and titration. Arch Intern Med 146(3):586–589PubMedGoogle Scholar
  48. Hu MH, Wang HS, Lin KL, Huang JL, Hsia SH, Chou ML, Hung PC, Hsieh MY, Wong AM (2008) Clinical experience of childhood hypertensive encephalopathy over an eight year period. Chang Gung Med J 31(2):153–158PubMedGoogle Scholar
  49. Immink RV, van den Born B-JH, van Montfrans GA, Kim Y-S, Hollmann MW, van Lieshout JJ (2008) Cerebral hemodynamics during treatment with sodium nitroprusside versus labetalol in malignant hypertension. Hypertension 52(2):236–240PubMedGoogle Scholar
  50. Immink RV, van den Born B-JH, van Montfrans GA, Koopmans RP, Karemaker JM, van Lieshout JJ (2004) Impaired cerebral autoregulation in patients with malignant hypertension. Circulation 110(15):2241–2245PubMedGoogle Scholar
  51. Ishikura K, Hamasaki Y, Sakai T, Hataya H, Mak RH, Honda M (2012) Posterior reversible encephalopathy syndrome in children with kidney diseases. Pediatr Nephrol 27(3):375–384PubMedGoogle Scholar
  52. Ishikura K, Ikeda M, Hamasaki Y, Hataya H, Shishido S, Asanuma H, Nishimura G, Hiramoto R, Honda M (2006) Posterior reversible encephalopathy syndrome in children: its high prevalence and more extensive imaging findings. Am J Kidney Dis 48(2):231–238PubMedGoogle Scholar
  53. Johnson CE, Jacobson PA, Song MH (1997) Isradipine therapy in hypertensive pediatric patients. Ann Pharmacother 31(6):704–707PubMedGoogle Scholar
  54. Kohaut EC, Wilson CJ, Hill LL (1975) Intravenous diazoxide in acute poststreptococcal glomerulonephritis. J Pediatr 87(5):795–798PubMedGoogle Scholar
  55. Kwon S, Koo J, Lee S (2001) Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Pediatr Neurol 24(5):361–364PubMedGoogle Scholar
  56. Lechner BL, Pascual JF, Roscelli JD (2005) Failure of fenoldopam to control severe hypertension secondary to renal graft rejection in a pediatric patient. Mil Med 170(2):130–132PubMedGoogle Scholar
  57. Lee GH, Lee IR, Park SJ, Kim JH, Oh JY, Shin JI (2015) Hypertensive crisis in children: an experience in a single tertiary care center in Korea. Clin Hypertens 22:10PubMedGoogle Scholar
  58. Leonard MB, Kasner SE, Feldman HI, Schulman SL (2001) Adverse neurologic events associated with rebound hypertension after using short-acting nifedipine in childhood hypertension. Pediatr Emerg Care 17(6):435–437PubMedGoogle Scholar
  59. Lewis VE, Peat DS, Tizard EJ (2001) Hypertension and facial palsy in middle aortic syndrome. Arch Dis Child 85(3):240–241PubMedPubMedCentralGoogle Scholar
  60. Luderer JR, Hayes AH Jr, Dubnsky O, Berlin CM (1977) Long-term administration of sodium nitroprusside in childhood. J Pediatr 91(3):490–491PubMedGoogle Scholar
  61. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, Invitti C, Litwin M, Mancia G, Pall D, Rascher W, Redon J, Schaefer F, Seeman T, Sinha M, Stabouli S, Webb NJ, Wuhl E, Zanchetti A (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J HypertensGoogle Scholar
  62. MacDonald JL, Johnson CE, Jacobson P (1994) Stability of isradipine in an extemporaneously compounded oral liquid. Am J Hosp Pharm 51(19):2409–2411PubMedGoogle Scholar
  63. Madre C, Orbach D, Baudouin V, Brisse H, Bessa F, Schleiermacher G, Pacquement H, Doz F, Michon J (2006) Hypertension in childhood cancer: a frequent complication of certain tumor sites. J Pediatr Hematol/Oncol 28(10):659–664Google Scholar
  64. Manning L, Robinson TG, Anderson CS (2014) Control of blood pressure in hypertensive neurological emergencies. Curr Hypertens Rep 16(6):436PubMedGoogle Scholar
  65. Marik PE, Varon J (2007) Hypertensive crises: challenges and management. Chest 131(6):1949–1962PubMedGoogle Scholar
  66. McBride BF, White CM, Campbell M, Frey BM (2003) Nicardipine to control neonatal hypertension during extracorporeal membrane oxygen support. Ann Pharmacother 37(5):667–670PubMedGoogle Scholar
  67. McCrory WW, Kohaut EC, Lewy JE, Lieberman E, Travis LB (1979) Safety of intravenous diazoxide in children with severe hypertension. Clin Pediatr 18 (11):661-663., 666–667, 671PubMedGoogle Scholar
  68. McLaine PN, Drummond KN (1971) Intravenous diazoxide for severe hypertension in childhood. J Pediatr 79(5):829–832PubMedGoogle Scholar
  69. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ (2007) Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 150 (6):640-644., 644.e641Google Scholar
  70. Messerli FH, Eslava DJ (2008) Treatment of hypertensive emergencies: blood pressure cosmetics or outcome evidence? J Hum Hypertens 22(9):585–586PubMedGoogle Scholar
  71. Michael J, Groshong T, Tobias JD (1998) Nicardipine for hypertensive emergencies in children with renal disease. Pediatr Nephrol 12(1):40–42PubMedGoogle Scholar
  72. Milou C, Debuche-Benouachkou V, Semama DS, Germain JF, Gouyon JB (2000) Intravenous nicardipine as a first-line antihypertensive drug in neonates. Intensive Care Med 26(7):956–958PubMedPubMedCentralGoogle Scholar
  73. Mitsnefes M, Stablein D (2005) Hypertension in pediatric patients on long-term dialysis: a report of the north American pediatric renal transplant cooperative study (NAPRTCS). Am J Kidney Dis 45(2):309–315PubMedGoogle Scholar
  74. Miyashita Y, Peterson D, Rees JM, Flynn JT (2010) Isradipine for treatment of acute hypertension in hospitalized children and adolescents. J Clin Hypertens (Greenwich) 12(11):850–855Google Scholar
  75. Moffett BS, Mott AR, Nelson DP, Goldstein SL, Jefferies JL (2008) Renal effects of fenoldopam in critically ill pediatric patients: a retrospective review. Pediatr Crit Care Med 9(4):403–406PubMedGoogle Scholar
  76. Murphy MB, Murray C, Shorten GD (2001) Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med 345(21):1548–1557PubMedGoogle Scholar
  77. Nakagawa TA, Sartori SC, Morris A, Schneider DS (2004) Intravenous nicardipine for treatment of postcoarctectomy hypertension in children. Pediatr Cardiol 25(1):26–30PubMedGoogle Scholar
  78. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 Suppl 4th Report):555–576Google Scholar
  79. Onder AM, Lopez R, Teomete U, Francoeur D, Bhatia R, Knowbi O, Hizaji R, Chandar J, Abitbol C, Zilleruelo G (2007) Posterior reversible encephalopathy syndrome in the pediatric renal population. Pediatr Nephrol 22(11):1921–1929PubMedGoogle Scholar
  80. Ostrye J, Hailpern SM, Jones J, Egan B, Chessman K, Shatat IF (2014) The efficacy and safety of intravenous hydralazine for the treatment of hypertension in the hospitalized child. Pediatr Nephrol 29(8):1403–1409PubMedGoogle Scholar
  81. Padilla Ramos A, Varon J (2014) Current and newer agents for hypertensive emergencies. Curr Hypertens Rep 16(7):450PubMedGoogle Scholar
  82. Paulson OB, Waldemar G, Schmidt JF, Strandgaard S (1989) Cerebral circulation under normal and pathologic conditions. Am J Cardiol 63(6):2c–5cPubMedGoogle Scholar
  83. Pavlakis SG, Frank Y, Chusid R (1999) Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathy: three names for an old syndrome. J Child Neurol 14(5):277–281PubMedGoogle Scholar
  84. Peacock WF, Hilleman DE, Levy PD, Rhoney DH, Varon J (2012) A systematic review of nicardipine vs labetalol for the management of hypertensive crises. Am J Emerg Med 30(6):981–993PubMedGoogle Scholar
  85. Pennisi AJ, Takahashi M, Bernstein BH, Singsen BH, Uittenbogaart C, Ettenger RB, Malekzadeh MH, Hanson V, Fine RN (1977) Minoxidil therapy in children with severe hypertension. J Pediatr 90(5):813–819PubMedGoogle Scholar
  86. Pitfield AF, Carroll AB, Kissoon N (2012) Emergency management of increased intracranial pressure. Pediatr Emerg Care 28(2):200–204.; quiz 205-207PubMedGoogle Scholar
  87. Pollack CV, Varon J, Garrison NA, Ebrahimi R, Dunbar L, Peacock WF (2009) Clevidipine, an intravenous dihydropyridine calcium channel blocker, is safe and effective for the treatment of patients with acute severe hypertension. Ann Emerg Med 53(3):329–338PubMedGoogle Scholar
  88. Pryds O, Edwards AD (1996) Cerebral blood flow in the newborn infant. Arch Dis Child Fetal Neonatal Ed 74(1):F63–F69PubMedPubMedCentralGoogle Scholar
  89. Rivkin MJ, Bernard TJ, Dowling MM, Amlie-Lefond C (2016) Guidelines for urgent Management of Stroke in children. Pediatr Neurol 56:8–17PubMedGoogle Scholar
  90. Sahney S (2006) A review of calcium channel antagonists in the treatment of pediatric hypertension. Paediatr Drugs 8(6):357–373PubMedGoogle Scholar
  91. Sasaki R, Hirota K, Masuda A (1997) Nifedipine-induced transient cerebral ischemia in a child with Cockayne syndrome. Anaesthesia 52(12):1236PubMedGoogle Scholar
  92. Sharma M, Kupferman JC, Brosgol Y, Paterno K, Goodman S, Prohovnik I, Kirkham FJ, Pavlakis SG (2010) The effects of hypertension on the paediatric brain: a justifiable concern. Lancet Neurol 9(9):933–940PubMedGoogle Scholar
  93. Shroff R, Roebuck DJ, Gordon I, Davies R, Stephens S, Marks S, Chan M, Barkovics M, McLaren CA, Shah V, Dillon MJ, Tullus K (2006) Angioplasty for renovascular hypertension in children: 20-year experience. Pediatrics 118(1):268–275PubMedPubMedCentralGoogle Scholar
  94. Skalina ME, Annable WL, Kliegman RM, Fanaroff AA (1983) Hypertensive retinopathy in the newborn infant. J Pediatr 103(5):781–786Google Scholar
  95. Sorof JM, Brewer ED, Portman RJ (1999) Ambulatory blood pressure monitoring and interdialytic weight gain in children receiving chronic hemodialysis. Am J Kidney Dis 33(4):667–674PubMedGoogle Scholar
  96. Stein DR, Ferguson MA (2016) Evaluation and treatment of hypertensive crises in children. Integr Blood Press Control 9:49–58PubMedPubMedCentralGoogle Scholar
  97. Still JL, Cottom D (1967) Severe hypertension in childhood. Arch Dis Child 42(221):34–39PubMedPubMedCentralGoogle Scholar
  98. Strandgaard S, Olesen J, Skinhoj E, Lassen NA (1973) Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1(5852):507–510PubMedPubMedCentralGoogle Scholar
  99. Strandgaard S, Paulson OB (1984) Cerebral autoregulation. Stroke 15(3):413–416PubMedGoogle Scholar
  100. Strauser LM, Groshong T, Tobias JD (2000) Initial experience with isradipine for the treatment of hypertension in children. South Med J 93(3):287–293PubMedGoogle Scholar
  101. Strife CF, Quinlan M, Waldo FB, et al. (1986) Minoxidil for control of acute blood pressure elevation in chronically hypertensive children. Pediatrics 78(5):861–865Google Scholar
  102. Suresh S, Mahajan P, Kamat D (2005) Emergency management of pediatric hypertension. Clin Pediatr (Phila) 44(9):739–745Google Scholar
  103. Tabbutt S, Nicolson SC, Adamson PC, et al. (2008) The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and children: a multicenter, double-blind, randomized trial. J Thorac Cardiovasc Surg 136(2):321–328PubMedGoogle Scholar
  104. Tenney F, Sakarcan A (2000) Nicardipine is a safe and effective agent in pediatric hypertensive emergencies. Am J Kidney Dis 35(5):E20PubMedGoogle Scholar
  105. Thomas C, Svehla L, Moffett BS (2009) Sodium-nitroprusside-induced cyanide toxicity in pediatric patients. Expert Opin Drug Saf 8(5):599–602PubMedGoogle Scholar
  106. Thomas CA (2011) Drug treatment of hypertensive crisis in children. Paediatr Drugs 13(5):281–290PubMedGoogle Scholar
  107. Thomas CA, Moffett BS, Wagner JL, Mott AR, Feig DI (2011) Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children. Pediatr Crit Care Med 12(1):28–32PubMedPubMedCentralGoogle Scholar
  108. Tirodker UH, Dabbagh S (2001) Facial paralysis in childhood hypertension. J Paediatr Child Health 37(2):193–194PubMedGoogle Scholar
  109. Tobias JD, Tulman DB, Bergese SD (2013) Clevidipine for perioperative blood pressure control in infants and children. Pharmaceuticals 6(1):70–84PubMedPubMedCentralGoogle Scholar
  110. Tontisirin N, Muangman SL, Suz P, Pihoker C, Fisk D, Moore A, Lam AM, Vavilala MS (2007) Early childhood gender differences in anterior and posterior cerebral blood flow velocity and autoregulation. Pediatrics 119(3):e610–e615PubMedGoogle Scholar
  111. Treluyer JM, Hubert P, Jouvet P, Couderc S, Cloup M (1993) Intravenous nicardipine in hypertensive children. Eur J Pediatr 152(9):712–714PubMedGoogle Scholar
  112. Trompeter RS, Smith RL, Hoare RD, Neville BG, Chantler C (1982) Neurological complications of arterial hypertension. Arch Dis Child 57(12):913–917PubMedPubMedCentralGoogle Scholar
  113. Truttmann AC, Zehnder-Schlapbach S, Bianchetti MG (1998) A moratorium should be placed on the use of short-acting nifedipine for hypertensive crises. Pediatr Nephrol 12(3):259PubMedGoogle Scholar
  114. Tullus K, Roebuck DJ, McLaren CA, Marks SD (2010) Imaging in the evaluation of renovascular disease. Pediatr Nephrol 25(6):1049–1056PubMedPubMedCentralGoogle Scholar
  115. Vade A, Agrawal R, Lim-Dunham J, Hartoin D (2002) Utility of computed tomographic renal angiogram in the management of childhood hypertension. Pediatr Nephrol 17(9):741–747PubMedGoogle Scholar
  116. Varon J, Marik PE (2008) Perioperative hypertension management. Vasc Health Risk Manag 4(3):615–627PubMedPubMedCentralGoogle Scholar
  117. Vavilala MS, Kincaid MS, Muangman SL, Suz P, Rozet I, Lam AM (2005) Gender differences in cerebral blood flow velocity and autoregulation between the anterior and posterior circulations in healthy children. Pediatr Res 58(3):574–578PubMedPubMedCentralGoogle Scholar
  118. Vavilala MS, Lee LA, Lam AM (2002a) Cerebral blood flow and vascular physiology. Anesthesiol Clin North Am 20(2):247–264Google Scholar
  119. Vavilala MS, Newell DW, Junger E, Douville CM, Aaslid R, Rivara FP, Lam AM (2002b) Dynamic cerebral autoregulation in healthy adolescents. Acta Anaesthesiol Scand 46(4):393–397PubMedGoogle Scholar
  120. Volpe J (2008) Hypoxic-ischemic encephalopathy: biochemical and physiologic aspects. In: Neurology of the newborn, 5th edn. Saunders Elsevier, Philadelphia, pp 291–324Google Scholar
  121. Vutskits L (2014) Cerebral blood flow in the neonate. Paediatr Anaesth 24(1):22–29PubMedGoogle Scholar
  122. Webb TN, Shatat IF, Miyashita Y (2014) Therapy of acute hypertension in hospitalized children and adolescents. Curr Hypertens Rep 16(4):425PubMedPubMedCentralGoogle Scholar
  123. Wells TG, Bunchman TE, Kearns GL (1990) Treatment of neonatal hypertension with enalaprilat. J Pediatr 117(4):664–667PubMedGoogle Scholar
  124. Williams KM, Shah AN, Morrison D, Sinha MD (2013) Hypertensive retinopathy in severely hypertensive children: demographic, clinical, and ophthalmoscopic findings from a 30-year British cohort. J Pediatr Ophthalmol Strabismus 50(4):222–228PubMedGoogle Scholar
  125. Wong LJ, Kupferman JC, Prohovnik I, Kirkham FJ, Goodman S, Paterno K, Sharma M, Brosgol Y, Pavlakis SG (2011) Hypertension impairs vascular reactivity in the pediatric brain. Stroke 42(7):1834–1838Google Scholar
  126. Wright RR, Mathews KD (1996) Hypertensive encephalopathy in childhood. J Child Neurol 11(3):193–196PubMedGoogle Scholar
  127. Wu HP, Yang WC, Wu YK, Zhao LL, Chen CY, Fu YC (2012) Clinical significance of blood pressure ratios in hypertensive crisis in children. Arch Dis Child 97(3):200–205PubMedGoogle Scholar
  128. Yang WC, Zhao LL, Chen CY, Wu YK, Chang YJ, Wu HP (2012) First-attack pediatric hypertensive crisis presenting to the pediatric emergency department. BMC Pediatr 12:200PubMedPubMedCentralGoogle Scholar
  129. Yiu V, Orrbine E, Rosychuk RJ, MacLaine P, Goodyer P, Girardin C, Gowrishankar M, Ogborn M, Midgley J, Filler G, Harley F (2004) The safety and use of short-acting nifedipine in hospitalized hypertensive children. Pediatr Nephrol 19(6):644–650PubMedGoogle Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.SSM Health Cardinal Glennon Children’s Medical CenterSaint Louis UniversitySt. LouisUSA

Section editors and affiliations

  • Karen M. Redwine
    • 1
  1. 1.Department of Pediatrics, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockUSA

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