[Hypertensive crisis]

Abstract

OBJECTIVE: Based on the review of the principal aspects of physiopathology, clinical presentation, and differential diagnosis, the article outlines the principles for the treatment of hypertensive crises in children, supporting early and systematic approach, with better short and long term prognoses. METHODS: Electronic research of the medical literature from the last twenty years (1979-1999) and protocols from intensive care and emergency services from USA and Canada were reviewed.RESULTS: Hypertensive crises in children can occur as primary presentation or in a child known as hypertensive. The differential diagnosis of the most common causes is based on the clinical history, physical examination and laboratory and bioimage studies. Renal (post-streptococcal glomerulonephritis, acute and chronic renal insufficiency, renal arterial stenosis) and cardiac (aortic stenosis) diseases are the most common causes in children. The treatment is directed by the clinical presentation: urgency or emergency crisis. The most used drugs are presented, together with clinical indications and pharmacological characteristics (route of administration, half-life, side effects). The general principles of treatment are described, improving the care of affected children.CONCLUSIONS: The treatment of hypertensive crises in children is based on the rational use of antihypertensive drugs for the different causes and clinical presentations, and on basic and advanced support of the systemic repercussions of the crises.