Hypertension (High BP)

Kumud P Mehta
Hypertensive Crisis
Hypertensive crisis is when hypertension increases to be severe enough to cause CNS, CVS, kidney or retinal involvement and quick control of BP is required to save the child and prevent permanent damage to these organs. The aim is to lower BP to 2/3 of its peak level using rapidly acting drugs for 24 - 48 hrs like sublingual nifedipine, IV Sodium nitroprusside, IV Labetolol or hydralazine. Subsequently oral medications can be used to bring BP to normal levels by 1 - 3 weeks. Very rapid reduction can result in poor perfusion of brain, coronary arteries, kidney etc. Simultaneously investigations, to arrive at the cause of hypertension should be started so that treatment can be offered.

Treatment of hypertension is urgently required to control BP in hypertensive emergencies to prevent damage to brain, heart, kidney and retina.

In cases with chronic hypertension which is moderate or severe, oral medicines are used depending on the cause. Diuretics are used in renal diseases with sodium and water retention. b blockers and vasodilators like propranolol, Hydralazine and recently even calcium channel blockers (nifedipine) and ACE inhibitors (enalapril) are used if hypertension is not controlled by diuretics, b blocker/vasodilator combinations. Initially single drug should be used and dose increased every 1 - 3 weeks and if after 2 - 3 weeks BP is still above 50th centile, new drug is added. Chronic hypertension may require treatment for years.

Mild to moderate hypertension with minimum symptoms may be controlled by non pharmacologic measures like weight reduction in obese children, diet control (low salt, high potassium, high calcium & magnesium and low fat diet), exercises - yoga, life style modification, reduction of stress etc.

Hypertension (High BP) Hypertension (High BP) 04/02/2001
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