Review Article

Emergency Management of Hypertension in Children

Table 7

Commonly used medications for hypertensive crisis.

MedicationDose and RouteMechanism of actionDuration of actionAdverse effectsContraindications and precautions

Sodium nitroprusside0.5–10 μg/kg/min I.VActs by releasing nitric oxide1-2 minuteshypotension, palpitations, headache, nausea, vomiting, raised intracranial pressure, thiocyanate and cyanide toxicity, thyroid suppressionIntracranial hypertension

Nicardipine1–3 μg/kg/min IVCalcium Channel Blocker15–30 minutes; may last for up to 3-4 hrsflushing, hypotension, palpitations, angina, syncope, peripheral edema, headache, vomitingrequires large fluid volume

Esmolol125–500 μg/kg/min intravenouslyBeta-blocker10–20 minutesbradycardia, hypotension, bronchoconstriction, skin necrosis after extravasation, Raynaud’s phenomenonAsthma, congestive cardiac failure, cocaine toxicity

Labetalol0.25–3 mg/kg/hr intravenouslyCombined alpha and beta blockerUp to 4 hrsbradycardia, hypotension, atrioventricular conduction disturbances, headache, bronchospasm, nasal congestion

Hydralazine0.1–0.6  mg/kg/dose every 4–6 hrs intravenouslyDirect vasodilatation of arterioles1–4 hrspalpitations, flushing, tachycardia, fever, rash, headache, arthralgia, SLE-like syndrome, positive ANA, peripheral neuropathy

Fenoldopam0.8–1.2 μg/kg/min intravenouslyDopamine D1 receptor agonist1 hrtachycardia, hypotension, flushing, headache, hypokalemia, nasal congestion

Phentolamine0.05–0.1 mg/kg/dose Intravenously (maximum of 5 mg per dose)Alpha-adrenergic blocker15–30 minutestachycardia, palpitations, hypotension, flushing, headache, nasal congestion, exacerbation of peptic ulcer

Enalaprilat5–10 mcg/kg/dose every 8–24 hrs intravenouslyAngiotensin-converting enzyme inhibitor4–6 hrshypotension, hyperkalemia, oliguria, rash, angioedema, agranulocytosis, neutropenia, cough, fatal hepatic necrosis (rare)patients with supra-renal aortic stenosis and bilateral renal stenosis; most valuable in neonatal hypertension

Nifedipine 0.1–0.25 mg/kg/dose every 4–6 hrs (maximum 10 mg/dose) oralCalcium channel blocker4–8 hrsFlushing, hypotension, tachycardia, palpitations, syncope, peripheral edema, headache, thrombocytopenia, rash, urticaria, elevated liver enzymes

Clonidine0.05–0.1 mg/dose orallyCentral alpha-agonist6–8 hrsbradycardia, hypotension, rebound hypertension with abrupt withdrawal, sedation, dry mouth,Avoid sudden discontinuation

Minoxidil0.1-0.2 mg/kg/day (maximum 5 mg/day) orallyHyperpolarization of K+ channels resulting in smooth muscle relaxationUp to 24 hrstachycardia, fluid retention, rash, headache, weight gain, pulmonary edema, Stevens-Johnson syndrome, photosensitivityPericardial effusion

Losartandose for less than 6 years is not established; for children >6 years 0.7 mg/kg once daily (maximum dose 100 mg/day) orallyAngiotensin II receptor blocker24 hrshypotension, chest pain, hyperkalemia, elevation in BUN/Creatinine, headache, fever, syncope, diarrhea, flu-like illnessPatient with suprarenal aortic stenosis and bilateral renal stenosis.

Clevidipine0.5–3.5 mcg/kg/min intravenouslyL-type calcium Channel blockerup to 15 minutesHeadache, nausea, vomiting, hypotensionPatients with lipid disorders and egg and soy protein allergies