Jordan University of Science and Technology, Irbid, Irbid, Jordan.
Pediatr Nephrol. 2017 Nov;32(11):2107-2113. doi: 10.1007/s00467-017-3720-6. Epub 2017 Jul 21.
Acute severe hypertension occurs infrequently in pediatric patients and, consequently, data on the efficacy and safety of most antihypertensive agents, as well as the adverse events associated with these agents, are very limited in this population. In this case series, we evaluated the use of metoprolol infusion in children with hypertensive emergencies.
The study population comprised children younger than 18 years who had been admitted to the pediatric intensive care unit at King Abdullah University Hospital with blood pressure above the 99th percentile for age, height, and sex and who were symptomatic at the time of presentation. Metoprolol was given as an infusion at a dose of 1-5 mcg/kg/min. The rate of decrease in blood pressure, side effects from the medication, and outcome were assessed.
Thirteen patients ranging in age from 2 months to 16 years were included in this study. The initial mean blood pressure was 23-75 mmHg above the 99th percentile for age, height, and sex. Metoprolol was initiated at a dose of 0.5 mcg/kg/min and titrated according to the target blood pressure to a maximum of 5 mcg/kg/min. Mean blood pressure fell by an average of 12.3, 20.4, and 27.1% at 1, 8, and 24 h, respectively, which is consistent with findings on the use of other intravenous medications reported in published studies. The heart rate did not decrease below the normal range for age. There were no significant side effects of the metoprolol infusion. All patients were discharged home with no neurological sequelae secondary to their hypertension.
An infusion of metoprolol for a hypertensive emergency is a safe and effective treatment for pediatric patients.
急性重度高血压在儿科患者中并不常见，因此，大多数降压药物的疗效和安全性的数据，以及这些药物相关的不良反应在该人群中非常有限。在本病例系列中，我们评估了在高血压危象的儿童中使用美托洛尔输注的情况。
研究人群包括因血压高于年龄、身高和性别第 99 百分位且有症状而被收入阿卜杜拉国王大学医院儿科重症监护病房的年龄小于 18 岁的儿童。美托洛尔以 1-5 mcg/kg/min 的剂量静脉输注。评估血压下降率、药物的副作用和结果。
本研究纳入了年龄在 2 个月至 16 岁之间的 13 例患者。初始平均血压比年龄、身高和性别第 99 百分位高 23-75 mmHg。美托洛尔以 0.5 mcg/kg/min 的起始剂量开始，并根据目标血压滴定至最大 5 mcg/kg/min。平均血压分别在 1、8 和 24 小时时下降了 12.3%、20.4%和 27.1%，这与已发表研究中报告的其他静脉内药物的使用结果一致。心率没有降至年龄正常范围以下。美托洛尔输注没有明显的副作用。所有患者均出院回家，无高血压继发的神经后遗症。
对于儿科患者，高血压危象时输注美托洛尔是一种安全有效的治疗方法。
