Hypertension in the Pediatric Intensive Care Unit

Abstract

Hypertension in the pediatric intensive care unit (PICU) is common and it contributes to the overall morbidity and mortality. Patients may present with hypertensive emergencies or hypertension can manifest itself later in PICU course. Although hypertension can be seen in most patients during hospitalization, patients with some specific diseases and conditions are more prone to hypertension. Hypertension should be recognized promptly and treated accordingly. Different pathophysiologic mechanisms can be responsible for the hypertension and management differs based on the underlying etiology. Any patient with a hypertensive emergency must be admitted to PICU, and treatment and diagnostic workup should be initiated immediately.

Keywords

hypertension - pediatric intensive care unit - hypertensive emergency

• References

• 1 Ehrmann BJ, Selewski DT, Troost JP, Hieber SM, Gipson DS. Hypertension and health outcomes in the PICU. Pediatr Crit Care Med 2014; 15 (5) 417-427
• 2 National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (2, Suppl 4th Report) 555-576
• 3 National Heart Lung and Blood Institute. Update on the task force report (1987) on high blood pressure in children and adolescents: a working group report from the National High Blood Pressure Education Program. Bethesda, MD: NIH publication; 1996. :vi, 24
• 4 Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007; 116 (13) 1488-1496
• 5 McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150 (6) 640-644 , 644.e1
• 6 Moore WE, Eichner JE, Cohn EM, Thompson DM, Kobza CE, Abbott KE. Blood pressure screening of school children in a multiracial school district: the Healthy Kids Project. Am J Hypertens 2009; 22 (4) 351-356
• 7 Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298 (8) 874-879
• 8 Park MK, Menard SW, Yuan C. Comparison of auscultatory and oscillometric blood pressures. Arch Pediatr Adolesc Med 2001; 155 (1) 50-53
• 9 Holt TR, Withington DE, Mitchell E. Which pressure to believe? A comparison of direct arterial with indirect blood pressure measurement techniques in the pediatric intensive care unit. Pediatr Crit Care Med 2011; 12 (6) e391-e394
• 10 Blake KV, Gurrin LC, Evans SF , et al. Adjustment for current weight and the relationship between birth weight and blood pressure in childhood. J Hypertens 2000; 18 (8) 1007-1012
• 11 Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other?. Am J Hypertens 1988; 1 (4 Pt 1): 335-347
• 12 Yiu V, Buka S, Zurakowski D, McCormick M, Brenner B, Jabs K. Relationship between birthweight and blood pressure in childhood. Am J Kidney Dis 1999; 33 (2) 253-260
• 13 Crump C, Winkleby MA, Sundquist K, Sundquist J. Risk of hypertension among young adults who were born preterm: a Swedish national study of 636,000 births. Am J Epidemiol 2011; 173 (7) 797-803
• 14 Hardy R, Kuh D, Langenberg C, Wadsworth ME. Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort. Lancet 2003; 362 (9391) 1178-1183
• 15 Smal JC, Uiterwaal CS, Bruinse HW, Steendijk P, van Bel F. Inverse relationship between birth weight and blood pressure in growth-retarded but not in appropriate for gestational age infants during the first week of life. Neonatology 2009; 96 (2) 86-92
• 16 Taylor SJ, Whincup PH, Cook DG, Papacosta O, Walker M. Size at birth and blood pressure: cross sectional study in 8–11 year old children. BMJ 1997; 314 (7079) 475-480
• 17 Guignard JP, Gouyon JB, Adelman RD. Arterial hypertension in the newborn infant. Biol Neonate 1989; 55 (2) 77-83
• 18 Norero C, Oto MA, Morales B , et al. [Renal artery thrombosis in newborn infants undergoing umbilical artery catheterization]. Rev Chil Pediatr 1989; 60 (6) 346-352
• 19 Ross EA, Reisfield GM, Watson MC, Chronister CW, Goldberger BA. Psychoactive “bath salts” intoxication with methylenedioxypyrovalerone. Am J Med 2012; 125 (9) 854-858
• 20 Lindeman E, Hultén P, Ström S, Enlund M, Al-Saffar Y, Helander A. [Increased abuse of the Internet drug MDPV in Västmanland. Severe cases of poisoning have given health care major problems]. Lakartidningen 2012; 109 (43–44) 1954-1957
• 21 Pappadis SL, Somers MJ. Hypertension in adolescents: a review of diagnosis and management. Curr Opin Pediatr 2003; 15 (4) 370-378
• 22 Sinaiko AR. Hypertension in children. N Engl J Med 1996; 335 (26) 1968-1973
• 23 Croix B, Feig DI. Childhood hypertension is not a silent disease. Pediatr Nephrol 2006; 21 (4) 527-532
• 24 Chandar J, Zilleruelo G. Hypertensive crisis in children. Pediatr Nephrol 2012; 27 (5) 741-751
• 25 Bower C, Ramsay JM. Congenital heart disease: a 10 year cohort. J Paediatr Child Health 1994; 30 (5) 414-418
• 26 Samánek M, Vorísková M. Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival: a prospective Bohemia survival study. Pediatr Cardiol 1999; 20 (6) 411-417
• 27 Sehested J, Baandrup U, Mikkelsen E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Implications for baroreceptor function. Circulation 1982; 65 (6) 1060-1065
• 28 Sehested J, Mikkelsen E. Aortic coarctation: the in vitro response to noradrenaline, potassium and prostaglandin F2 alpha in intercostal arteries. Gen Pharmacol 1983; 14 (1) 155-156
• 29 Kenny D, Polson JW, Martin RP, Paton JF, Wolf AR. Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology. Hypertens Res 2011; 34 (5) 543-547
• 30 Parker Jr FB, Farrell B, Streeten DH, Blackman MS, Sondheimer HM, Anderson Jr GH. Hypertensive mechanisms in coarctation of the aorta. Further studies of the renin-angiotensin system. J Thorac Cardiovasc Surg 1980; 80 (4) 568-573
• 31 de Divitiis M, Pilla C, Kattenhorn M , et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001; 104 (12) (Suppl. 01) I165-I170
• 32 Bergoënd E, Texier N, Legendre A , et al. [The role of aortic morphology in the occurrence of hypertension in patients undergoing surgery for coarctation of the aorta before the age of 1 year]. Arch Mal Coeur Vaiss 2006; 99 (5) 439-445
• 33 Canniffe C, Ou P, Walsh K, Bonnet D, Celermajer D. Hypertension after repair of aortic coarctation—a systematic review. Int J Cardiol 2013; 167 (6) 2456-2461
• 34 Sealy WC, De Maria W, Harris J. Studies of the development and nature of the hypertension in experimental coarctation of the aorta. Surg Gynecol Obstet 1950; 90 (2) 193-198
• 35 Wiest DB, Garner SS, Uber WE, Sade RM. Esmolol for the management of pediatric hypertension after cardiac operations. J Thorac Cardiovasc Surg 1998; 115 (4) 890-897
• 36 Bojar RM, Weiner B, Cleveland RJ. Intravenous labetalol for the control of hypertension following repair of coarctation of the aorta. Clin Cardiol 1988; 11 (9) 639-641
• 37 Tabbutt S, Nicolson SC, Adamson PC , et al. The safety, efficacy, and pharmacokinetics of esmolol for blood pressure control immediately after repair of coarctation of the aorta in infants and children: a multicenter, double-blind, randomized trial. J Thorac Cardiovasc Surg 2008; 136 (2) 321-328
• 38 Miller CP, Cook AM, Case CD, Bernard AC. As-needed antihypertensive therapy in surgical patients, why and how: challenging a paradigm. Am Surg 2012; 78 (2) 250-253
• 39 Heij HA, Ekkelkamp S, Vos A. Hypertension associated with skeletal traction in children. Eur J Pediatr 1992; 151 (7) 543-545
• 40 Hogenson KD. Acute postoperative hypertension in the hypertensive patient. J Post Anesth Nurs 1992; 7 (1) 38-44
• 41 Wallach R, Karp RB, Reves JG, Oparil S, Smith LR, James TN. Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: a study of hemodynamic and humoral factors. Am J Cardiol 1980; 46 (4) 559-565
• 42 Berliner BC, Shenker IR, Weinstock MS. Hypercalcemia associated with hypertension due to prolonged immobilization. (An unusual complication of extensive burns). Pediatrics 1972; 49 (1) 92-96
• 43 Earll JM, Kurtzman NA, Moser RH. Hypercalcemia and hypertension. Ann Intern Med 1966; 64 (2) 378-381
• 44 Little JA, Dean Jr AE, Chapman M. Immobilization hypercalcemia. South Med J 1982; 75 (4) 502
• 45 Ponticelli C, Cucchiari D, Graziani G. Hypertension in kidney transplant recipients. Transpl Int 2011; 24 (6) 523-533
• 46 Mangray M, Vella JP. Hypertension after kidney transplant. Am J Kidney Dis 2011; 57 (2) 331-341
• 47 Popovtzer MM, Pinnggera W, Katz FH , et al. Variations in arterial blood pressure after kidney transplantation. Relation to renal function, plasma renin activity, and the dose of prednisone. Circulation 1973; 47 (6) 1297-1305
• 48 Bachy C, Alexandre GP, van Ypersele de Strihou C. Hypertension after renal transplantation. BMJ 1976; 2 (6047) 1287-1289
• 49 Thomas B, Taber DJ, Srinivas TR. Hypertension after kidney transplantation: a pathophysiologic approach. Curr Hypertens Rep 2013; 15 (5) 458-469
• 50 Wadei HM, Textor SC. Hypertension in the kidney transplant recipient. Transplant Rev (Orlando) 2010; 24 (3) 105-120
• 51 Chatzikyrkou C, Menne J, Gwinner W , et al. Pathogenesis and management of hypertension after kidney transplantation. J Hypertens 2011; 29 (12) 2283-2294
• 52 Luke RG. Hypertension in renal transplant recipients. Kidney Int 1987; 31 (4) 1024-1037
• 53 Campistol JM, Romero R, Paul J, Gutiérrez-Dalmau A. Epidemiology of arterial hypertension in renal transplant patients: changes over the last decade. Nephrol Dial Transplant 2004; 19 (Suppl. 03) iii62-iii66
• 54 Seratnahaei A, Shah A, Bodiwala K, Mukherjee D. Management of transplant renal artery stenosis. Angiology 2011; 62 (3) 219-224
• 55 Hurst FP, Abbott KC, Neff RT , et al. Incidence, predictors and outcomes of transplant renal artery stenosis after kidney transplantation: analysis of USRDS. Am J Nephrol 2009; 30 (5) 459-467
• 56 Henning BF, Kuchlbauer S, Böger CA , et al. Percutaneous transluminal angioplasty as first-line treatment of transplant renal artery stenosis. Clin Nephrol 2009; 71 (5) 543-549
• 57 Pranzatelli MR, Pavlakis SG, Gould RJ, De Vivo DC. Hypothalamic-midbrain dysregulation syndrome: hypertension, hyperthermia, hyperventilation, and decerebration. J Child Neurol 1991; 6 (2) 115-122
• 58 Blackman JA, Patrick PD, Buck ML, Rust Jr RS. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol 2004; 61 (3) 321-328
• 59 Clifton GL, Ziegler MG, Grossman RG. Circulating catecholamines and sympathetic activity after head injury. Neurosurgery 1981; 8 (1) 10-14
• 60 Schirmer-Mikalsen K, Vik A, Gisvold SE, Skandsen T, Hynne H, Klepstad P. Severe head injury: control of physiological variables, organ failure and complications in the intensive care unit. Acta Anaesthesiol Scand 2007; 51 (9) 1194-1201
• 61 Prodhan P, McCage LS, Stroud MH , et al. Acute kidney injury is associated with increased in-hospital mortality in mechanically ventilated children with trauma. J Trauma Acute Care Surg 2012; 73 (4) 832-837
• 62 Fang L, You H, Chen B , et al. Mannitol is an independent risk factor of acute kidney injury after cerebral trauma: a case-control study. Ren Fail 2010; 32 (6) 673-679
• 63 Bratton SL, Chestnut RM, Ghajar J , et al; Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 2007; 24 (Suppl. 01) S59-S64
• 64 Kochanek PM, Carney N, Adelson PD , et al; American Academy of Pediatrics-Section on Neurological Surgery; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Child Neurology Society; European Society of Pediatric and Neonatal Intensive Care; Neurocritical Care Society; Pediatric Neurocritical Care Research Group; Society of Critical Care Medicine; Paediatric Intensive Care Society UK; Society for Neuroscience in Anesthesiology and Critical Care; World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents—second edition. Pediatr Crit Care Med 2012; 13 (Suppl. 01) S1-S82
• 65 Hammer GB, Verghese ST, Drover DR, Yaster M, Tobin JR. Pharmacokinetics and pharmacodynamics of fenoldopam mesylate for blood pressure control in pediatric patients. BMC Anesthesiol 2008; 8: 6
• 66 Costello JM, Thiagarajan RR, Dionne RE , et al. Initial experience with fenoldopam after cardiac surgery in neonates with an insufficient response to conventional diuretics. Pediatr Crit Care Med 2006; 7 (1) 28-33
• 67 Flynn JT, Tullus K. Severe hypertension in children and adolescents: pathophysiology and treatment. Pediatr Nephrol 2009; 24 (6) 1101-1112
• 68 Palmer RF, Lasseter KC. Drug therapy. Sodium nitroprusside. N Engl J Med 1975; 292 (6) 294-297
• 69 Smith RP, Kruszyna H. Nitroprusside produces cyanide poisoning via reaction with hemoglobin. J Pharmacol Exp Ther 1974; 191 (3) 557-563
• 70 Wells TG, Bunchman TE, Kearns GL. Treatment of neonatal hypertension with enalaprilat. J Pediatr 1990; 117 (4) 664-667
• 71 Deal JE, Barratt TM, Dillon MJ. Management of hypertensive emergencies. Arch Dis Child 1992; 67 (9) 1089-1092
• 72 Hulse JA, Taylor DS, Dillon MJ. Blindness and paraplegia in severe childhood hypertension. Lancet 1979; 2 (8142) 553-556
• 73 Singh D, Akingbola O, Yosypiv I, El-Dahr S. Emergency Management of Hypertension in Children. Int J Nephrol 012; 2012; 1-15