Aetiology and Long-Term Outcome of Hypertension Emergencies in Children

Background: Hypertension emergencies are not uncommon in children. A hypertensive emergency is a associated with severe BP elevation and organ damage, There is paucity of literature on the outcome of hypertensive crisis in children. Therefore, we conducted this study in hospitalized children who presented with hypertension emergencies. Methods: The study population consisted of 39 children who were admitted with accelerated hypertension with the diagnosis of hypertension emergency . The study duration was from April 17 to Dec. 23..Demographic data and and relevant investigations were recorded. Hypertension emergency was diagnosed when a child's BP was 30 mm Hg or more above the 95th percentile for age and height at presentation with target organ damage. Results: The gender ratio was 8:5 (M:F). The mean age of patients was 11.9+ 4.3 years. The study cohort had mean s. creatinine and BUN of 2.4 + 1.7 mg % and 33.4+ 4.9 mg%. The cohort had a mean 24-hour proteinuria of 1.5 gm + .65 gm%. Mean systolic BP was 175 + 18.7 mm Hg and Diastolic BP was 98.5 + 10.3 mm Hg. Most patients (87%) had hypertension due to renal parenchymal disease (RPD) while 7.6 % had renovascular disease (aortoarteritis) and 2.6 % had essential hypertension. Post-infectious glomerulonephritis (PIGN), Thrombotic microangiopathy (TMA) and IgA nephropathy were the most common causes of RPD.. Headache (53.8%) was the most common presenting symptom. Other symptoms were blurred vision (35%), vomiting (30%) and dyspnoea (25%). 15 patients had oliguria. 21 patients needed dialysis . Labetalol and nitro-glycerine infusion were used to control BP. The mean time to control BP was 3.8 days. 7 patients had normalisation of BP. Five patients died. Eight patients remained dialysis dependent. The mean follow-up was 37+5.8 months. Mean s. creatinine was 2.2 +1.1 mg% at the last follow-up..54% patients achieved control of BP. Univariate analysis revealed that Proteinuria of more than 500 mg daily, dialysis dependency at 2 weeks, Hb < 7.5 gm%, and uncontrolled BP after 2 weeks were associated with dialysis dependency. Multivariate analysis showed that proteinuria > 500 mg daily and dialysis dependency at 2 weeks were predictor of dialysis dependency. Conclusion: Hypertensive emergency in children is mostly due to RPD. Significant proteinuria, dialysis dependency at 2 weeks, Hb < 7.5 gm% and uncontrolled BP at 2 weeks were predictive of dialysis dependency,