Management of Hypertensive Emergencies

The emergency management of severe hypertension in a child includes careful clinical assessment before embarking on specific drug treatment. In particular, consideration of the degree of systemic illness, and the relative likelihood of specific causes of the hypertension, will usually warrant multi-discliplinary care, often within the intensive therapy unit. Intravenous labetalol and sodium nitroprusside are commonly used in this situation, but more recently intravenous nicardipine has also been found to be valuable. Oral short-acting nifedipine can be given, but its use is controversial as the effect is less predictable. Whichever drug is prescribed, the aim is to reduce blood pressure slowly with careful blood pressure monitoring, as the complications of a precipitate drop in blood pressure are as serious as those of severe hypertension