Pediatric Hypertension

Definition:

  • Hypertension is defined as > 2 standard deviations above the mean for age and sex, with three measurements obtained in non-stressful circumstances.
  • Measurements must be taken by a cuff of appropriate size (1/2 to 2/3 the length of the upper arm with inflatable bladder encircling the arm).

Supportive Data:

Hypertension can be classified as:

  • Primary or essential hypertension
  • Secondary hypertension: renal, endocrine, cardiac, or neurological

Upper limits of normal BP:

Age Systolic BP Diastolic BP
<2 years 110 65
3 - 6 years 120 70
7 - 10 years 130 75
11 - 15 years 140 80

Guidelines:

  1. Airway: supplemental oxygen for acutely symptomatic patient.
  2. Check child for adequacy of ventilation as hypercarbia may cause increased BP.
  3. Aim to lower mean BP (MBP) by 20 - 25%. DO NOT aim to achieve normal BP.
  4. Short acting antihypertensive agents:
    1. Hydralazine (Apresoline) 0.1 - 0.2 mg/kg/dose IM/IV (Max dose of 20 mg).
  5. Fluid management (see: Fluid and Blood Component Therapy)
  6. Careful assessment for volume status. Consult control physician for volume overload.

NOTE: For the pediatric patient with traumatic brain injury, treatment should be directed at the ABC’s and treatment of increased intracranial pressure. Avoid use of antihypertensive agents.

NOTE: Consult control physician for persistent symptomatic hypertension that is unresponsive to treatment per above protocol.

Consider:

  • Nicardipine (Cardene) continuous IV infusion starting at 0.5 mcg/kg/minute and increasing by 0.5mcg/kg/min every 10 minutes to desired BP (not to exceed 5 mcg/kg/minute).
  • Nitroprusside: 0.25-4 mcg/kg/min IV infusion. Requires frequent (at least every 5 min) monitoring of BP.

Citations/References:

  1. Prineas RJ. Blood pressure in children and adolescents. In: Bulpitt CJ, ed. Epidemiology of Hypertension. New York, NY: Elsevier; 2000:86–105. Birkenhager WH and Reid JL, eds. Handbook of Hypertension, Vol. 20.

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