Department of Pediatrics and Biomedical Center, 2nd Faculty of Medicine and Faculty of Medicine in Pilsen, Charles University in Prague, V Uvalu 84, 15006, Prague 5, Czech Republic.
Motol University Hospital, V Uvalu 84, 15006, Prague 5, Czech Republic.
Pediatr Nephrol. 2019 Dec;34(12):2523-2537. doi: 10.1007/s00467-018-4092-2. Epub 2018 Oct 1.
Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician's initial management of a hypertensive crisis. The main aim of the treatment of hypertensive crisis is the prevention or treatment of life-threatening complications of hypertension-induced organ dysfunction, including neurologic, ophthalmologic, renal, and cardiac complications. While the treatment strategy must be directed toward the immediate reduction of BP to reduce the hypertensive damage to these organs, it should not be at a too fast rate to cause hypoperfusion of vital organs by an excessively rapid reduction of BP. Thus, intravenous continuous infusions rather than intravenous boluses of antihypertensive medications should be the preferable mode of initial treatment of children with hypertensive emergency.
高血压危象在儿童中相对少见。然而，如果不治疗，可能会危及生命，并导致重要器官的不可逆转损伤。尽管血压同样高，但高血压危象患者的临床表现可能从非常轻微（高血压急症）到严重症状（高血压紧急情况）不等。对于以高血压就诊的患者，应进行个体化评估，重点评估靶器官损伤，而不是特定的血压数值，这是指导医生初始处理高血压危象的关键。高血压危象治疗的主要目的是预防或治疗高血压引起的器官功能障碍的危及生命的并发症，包括神经、眼科、肾脏和心脏并发症。虽然治疗策略必须针对立即降低血压以减少高血压对这些器官的损害，但不应过快降低血压，以免因血压过快下降导致重要器官灌注不足。因此，静脉持续输注而非静脉推注降压药物应是治疗高血压急症儿童的首选初始治疗方式。
