1. Hypertensive Emergencies Malcolm A. Lewis Consultant Paediatric Nephrologist

2. 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

3. Casual BP centiles - Boys

4. Casual BP centiles - Girls

5. Rule of thumb

6. But;

8. And;

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

10. Q2. Is the patient symptomatic?

11. Symptoms in hypertension

12. PRES (Posterior reversible encephalopathy syndrome)

13. Q3. Is there an evident cause?

14. Causes of hypertension

15. Approach to the patient with hypertension

16. H E A T

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

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

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

20. Approach to the patient with hypertension H E A Treatment

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

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

23. 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

24. 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.

25. Treatment of severe hypertension