Hypertensive crisis in children

Hypertensive crisis - a sudden increase in blood pressure, causing significant deterioration in health and requiring emergency care.

In children and adolescents, hypertensive crises predominate in secondary (symptomatic) arterial hypertension.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of secondary arterial hypertension

• Diseases of the kidneys and kidney vessels (acute and chronic glomerulonephritis, pyelonephritis, stenosis and thrombosis of the renal arteries, kidney hypoplasia, reflux-nephropathy, hydronephrosis, Wilms tumor, condition after kidney transplantation, etc.).
• Diseases of the heart and blood vessels (coarctation of the aorta, aortoarteritis, aortic valve insufficiency).
• Endocrine diseases (pheochromocytoma, hyperaldosteronism, hyperthyroidism, hyperparathyroidism, Cushing's syndrome, diencephalic syndrome).
• Diseases of the central nervous system (brain trauma, intracranial hypertension).
• Reception of medicines (simpatomimetiki, glucocorticosteroids, anabolic steroids, drugs (codeine, etc.)).

However, in children of older age and adolescents, hypertensive crisis can occur with primary arterial hypertension.

[10], [11], [12], [13], [14]

Symptoms of hypertensive crisis

The clinical picture depends on the type of hypertensive crisis.

Hypertensive crisis I type. Characteristic is a sudden increase in systolic (predominantly), diastolic and pulsatile arterial pressure. At the same time, neurovegetative and cardiac complaints predominate in children. They have a severe headache, dizziness, nausea, sometimes vomiting, weakness. Children are nervous, feel a sense of fear. Typical complaints are palpitations, pain in the heart. Often there are red spots on the face and body, cold extremities, chills, shivering, sweating, impaired vision and hearing. After a crisis, as a rule, a large amount of urine is released with a low specific gravity. At a laboratory examination, leukocytosis is determined in the blood, the serum glucose level is increased, signs of hypercoagulation are revealed, in the urine - proteinuria, hyaline cylinders. The duration of the attack is usually not more than 2-3 hours.

Hypertensive type II crisis develops more slowly. Patients significantly increase systolic and especially diastolic blood pressure, and pulse - does not change or decreases. In the clinical picture, changes in the central nervous system predominate, the level of norepinephrine in the blood is increased at normal glucose levels. Duration can be from several hours to several days.

In hypertensive crises, complications that threaten the child's life may occur: hypertensive encephalopathy, edema of the brain, hemorrhagic or ischemic stroke, subarachnoid hemorrhage, pulmonary edema, acute renal failure, retinopathy, retinal bleeding.

Classification of hypertensive crises

• I type - hyperkinetic (sympathoadrenal. Neurovegetative).
• II type - hypokinetic (noradrenaline, water-salt).

[15], [16], [17], [18], [19]

Emergency care for hypertensive crisis

AD recommended to reduce gradually to the upper limits of the age norm. In the first hour, systolic blood pressure is reduced by no more than 20-25% of the initial value, diastolic - no more than 10%.

Children with hypertensive crisis are shown strict bed rest; frequent (every 10-15 minutes) determination of blood pressure, constant assessment of health status; if necessary, record an electrocardiogram. Treatment of hypertensive crisis depends on the presence of complications.

[20], [21], [22], [23], [24], [25], [26]

Uncomplicated hypertensive crisis

• Hypertensive crisis I type. His treatment, especially in the presence of tachycardia, it is advisable to start with the introduction of beta-adrenoblockers (atenolol is administered at a rate of 0.7-1.5 mg / kghs), metoprolol - 3-5 mg / kghsut). Treatment can also begin with nifedipine, which is administered under the tongue or inward at a dose of 0.25-0.5 mg / kg. If the effect is insufficient, clonidine may be used at a dose of 0.002 mg / kg under the tongue or inwards, captopril [1-2 mg / kgsut]] sublingually, 0.25% solution of droperidol (0.1 mg / kg) intravenously.
• Hypertensive type II crisis. In the first place, nifedipine should be administered under the tongue (0.25-0.5 mg / kg). Simultaneously with nifedipine, a fast-acting diuretic furosemide is prescribed from the calculation of 1-2 mg / kg intravenously struino. Following this, it is recommended to prescribe ACE inhibitors. With the excitation, high activity of the sympathoadrenal system, the use of droperidol, diazepam (0.25-0.5 mg / kg) was justified.

Complicated hypertensive crisis

• Hypertonic encephalopathy, acute disturbance of cerebral circulation, convulsive syndrome. In addition to nifedipine and furosemide, a 0.01% solution of clonidine is administered intramuscularly or intravenously, magnesium sulfate, diazepam. In addition, sodium nitroprusside can be dripped intravenously at a dose of 0.5-10 mg / kghmin) with gradual increase
  or use of ganglion blockers.
• Acute left ventricular failure. In the hypertensive crisis with manifestations of acute left ventricular failure, emergency treatment is recommended starting with intravenous nitroglycerin (0.1-0.7 μg / kghmin)], sodium nitroprusside (2-5 μg / kghmin) or hydralazine (0.2-0 , 5 mg / kg). In addition, it is necessary (especially with pulmonary edema) to appoint furosemide. With insufficient effect, clonidine, droperidol, diazepam are used.
• Pheochromocytoma. Catecholamine crises are stopped with a-adrenoblockers. Fentolamine is diluted in 0.9% solution of sodium chloride and administered intravenously very slowly at 0.5-1 mg every 5 minutes until the normalization of blood pressure). Tropodifene is administered intravenously very slowly at 1-2 mg every 5 minutes until the blood pressure decreases).

[27], [28], [29], [30], [31]