2017 American Academy of Pediatrics updated definitions for pediatric blood pressure categories

Hypertensive Urgency: Stage II hypertension without symptoms or evidence of end-organ damage. In this case, urgent medical intervention is needed to bring down the blood pressure, but it is not considered an emergency situation.

Hypertensive Emergency: Stage II hypertension with signs of end-organ damage (eg: seizures, encephalopathy, AKI, heart failure) that warrants immediate medical intervention to lower the blood pressure and prevent further damage to the organs.

Causes of Hypertension

Diagnosis

In general, hypertension workups can be done outpatient after failure of lifestyle modifications and should be tailored based on suspected secondary causes. Workup is indicated in the ED in cases of severe acute hypertension. Some studies to consider include:

Acute Hypertension Management

In general, PRN antihypertensives are indicated when blood pressure is >95th%ile + 12 mmHg for age or >140/90 (stage II HTN)

1. Treat underlying cause. Consider easily reversible causes (pain, fever, anxiety).

2. For hypertensive urgency, start PO isradipine or IV hydralazine

3. For hypertensive emergencies, start IV labetalol bolus with a continuous infusion or nicardipine infusion.

   1. Over 8 hours, lower BP no more than 25% of the difference between the current SBP and the SBP goal.

   2. IV Hydralazine is not suitable as it has a slower onset of action and a longer duration of action which can cause inadvertent hypotension and end-organ ischemia.

4. Consider diuretics if signs of volume overload