Hypertensive Emergencies Malcolm A. Lewis Consultant Paediatric Nephrologist

Q1. Is the patient hypertensive? High normal or pre-hypertension 90 th to 95 th centile Stage 1 hypertension 95 th centile to 99 th + 5 mmHg Stage 2 hypertension > 99 th centile + 5 mmHg Severe hypertension > 95 th centile + 20 mmHg

Casual BP centiles - Boys

Casual BP centiles - Girls

Rule of thumb

But;

And;

Q1. Is the patient hypertensive? High blood pressure –Properly taken –Repeatedly taken –Checked manually Or; High blood pressure with symptoms

Q2. Is the patient symptomatic?

Symptoms in hypertension

PRES (Posterior reversible encephalopathy syndrome)

Q3. Is there an evident cause?

Causes of hypertension

Approach to the patient with hypertension

H E A T

Approach to the patient with hypertension History E A T Duration of symptoms if any Previous medical history Family history Drug history

Approach to the patient with hypertension H Examination A T Height and Weight Cutaneous stigmata Four limb BP Oedema / fluid overload Cardiomegaly

Approach to the patient with hypertension H E Assessment T FBC, biochemical profile Urinalysis Renal tract US ECG, echo if possible CXR

Approach to the patient with hypertension H E A Treatment

Treatment of severe hypertension 1.Does the patient have obstructive uropathy? –Urinary catheter –Nephrostomy

Treatment of severe hypertension 1.Does the patient have obstructive uropathy? 2.Is the patient fluid overloaded? –Diuretics

Treatment of severe hypertension 1.Does the patient have obstructive uropathy? 2.Is the patient fluid overloaded? 3.Is there another known cause for hypertension? –Treat or adjust targeted therapy

Treatment of severe hypertension 1.Does the patient have obstructive uropathy? 2.Is the patient fluid overloaded? 3.Is there another known cause for hypertension? 4.If none of the above discuss and consider antihypertensive treatment.

Treatment of severe hypertension