Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Münster, Germany.
Int J Clin Pharm. 2011 Apr;33(2):165-76. doi: 10.1007/s11096-011-9495-0. Epub 2011 Mar 12.
This work presents a short overview on the available data about drugs that are currently used to treat hypertensive emergencies in children with a focus on incidents after stem cell transplantation. It shows that the pediatric use of all hypotensive agents appears to be mainly based on personal experience of the attending physicians rather than on convincing clinical trials.
A literature search was performed in MEDLINE, through PubMed, using the medical subject headings (MeSH) hypertensive emergencies, nifedipine, nicardipine, and children. Further articles were identified by checking cross-references of articles and books.
Hypertensive emergencies in children after stem cell transplantation usually have a renal etiology, because of the treatment with the calcineurin inhibitors cyclosporine and tacrolimus. In these severe cases an immediate action is necessary to avoid possible appearance or exacerbation of endorgan damage. Because of their mechanism of action and a potential nephroprotective effect calcium channel blockers may be particularly suitable in cases of hypertensive emergencies. An intravenous application of nifedipine may compensate the difficulties of accurate dosing, but keeping in mind possible severe side effects and the lack of published experience its use in children is at least questionable. Nicardipine appears to be the hypotensive agent of first choice. In adults, the treatment of hypertensive emergencies with intravenous nicardipine is well-documented, but for an evaluation of safety in pediatric use, the published studies and case reports appear to be barely adequate.
The actual treatment approaches vary widely, demonstrating the lack of hard science on which current treatment of hypertensive emergencies in children is based. The hypotensive agent for the individual situation should be chosen considering the properties, side effects, the limited experiences with its use and the patient's anamnesis.
本研究旨在对目前用于治疗儿童高血压急症的药物进行综述，重点关注干细胞移植后发生的药物不良反应。研究结果表明，所有降压药物在儿科的应用主要基于主治医生的个人经验，而非令人信服的临床试验。
在 MEDLINE 上通过 PubMed 以高血压急症、硝苯地平、尼卡地平、儿童为主题词进行文献检索。通过检查文章和书籍的交叉引用进一步确定其他相关文章。
干细胞移植后儿童的高血压急症通常具有肾性病因，这是由于环孢素和他克莫司等钙调磷酸酶抑制剂的治疗作用。在这些严重情况下，必须立即采取行动，以避免可能出现或恶化的靶器官损伤。由于其作用机制和潜在的肾保护作用，钙通道阻滞剂可能特别适用于高血压急症。静脉应用硝苯地平可能会补偿准确给药的困难，但应牢记可能出现的严重副作用，并且由于缺乏已发表的经验，其在儿童中的应用至少值得怀疑。尼卡地平似乎是首选的降压药。在成人中，静脉内应用尼卡地平治疗高血压急症已有充分的文献记载，但为了评估其在儿科应用中的安全性，发表的研究和病例报告似乎远远不够。
目前的治疗方法差异很大，这表明缺乏支持儿童高血压急症治疗的硬性科学依据。应根据药物特性、副作用、有限的使用经验和患者病史来选择适合个体情况的降压药。
