Clinical Analysis of Hypertension in Children Admitted to the Emergency Department
Received 18 February 2009; received in revised form 29 June 2009; accepted 24 July 2009.
Background
Hypertension in children is a relatively rare disease and has a high risk of further severe damage. The current study aimed to survey the clinical spectrum of hypertension in children admitted to an emergency department (ED).
Methods
We reviewed the medical records of all children aged 18 years and younger in whom a diagnosis of hypertension was made at the ED in Changhua Christian Hospital between 1998 and 2008. The patients were divided into four age groups (infants, preschool-age, school-age and adolescents) and three severity levels (transient hypertension, hypertension and hypertensive crisis). Case distribution analysis of hypertension based on different months and years was performed. Body mass index, blood pressure, etiologies and presenting symptoms were also analyzed according to age groups and severity levels.
Results
A total of 99 children met the inclusion criteria and were included in the current study. Diagnoses included 15 transient hypertension (15.1%), 28 hypertension (28.3%) and 56 hypertensive crises (56.6%). Almost all of the hypertensive crisis patients presented with stage 2 hypertension (n = 55, 98.2%). Dizziness and headache were the most common presenting symptom in patients in school-age and adolescent groups. Of the symptoms described, altered mental status and coma were most common in preschool-age and school-age groups. Neurologic disorder (26.3%) was the most common etiology in children younger than 6 years of age, followed by renal disorders (21.0%). In children older than 6 years of age, the major etiologies of hypertension and hypertensive crisis included untreated primary hypertension, renal disorders and endocrine disorders.
Conclusion
Hypertension in children may be easily underestimated but is potentially life-threatening in the pediatric ED. Primary care clinicians should promptly identify patients with stage 2 hypertension and treat them immediately and appropriately to prevent damage to cardiovascular organs.
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aDepartment of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
bDepartment of Pediatrics, Buddhist Tzu Chi General Hospital, Taichung, Taiwan
cInstitute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
Corresponding author. Department of Pediatrics, Buddhist Tzu-Chi General Hospital, Taichung Branch, 66 Fongsing Road, Section 1, Tanzih, Taichung 42743, Taiwan
ABSTRACT