Initial management of hypertensive urgencies in children and adolescents

BP: blood pressure; ICP: intracranial pressure; IV: intravenous.
* Typically, BP is >30 mmHg above the 95^th percentile for age, sex, and height. The absolute level of BP elevation is less important than whether symptoms of end-organ damage are present. Auscultation is the preferred method during repeat measurement; appropriate cuff size and placement should be ensured. Refer to UpToDate content on pediatric hypertensive urgencies and normal BP in children.
¶ Refer to UpToDate content on management of hypertensive emergencies in children.
Δ Refer to the UpToDate topics on evaluation of hypertensive emergencies and urgencies in children and adolescents.
◊ The treatment goal for children with hypertensive urgencies depends upon the clinical situation. The ultimate goal would be a systolic BP <90^th percentile for age, sex, and height in children <13 years of age or <130/80 in adolescents ≥13 years of age. However, a higher goal such as the 95^th percentile may be appropriate initially. Patients with an acute BP elevation warrant urgent treatment to the systolic goal BP over several hours. For children with chronic hypertension due to a known condition (eg, chronic kidney disease) in which BP has increased gradually over time, lowering of the BP should occur less quickly (eg, over 1 to 2 days or more).
§ Refer to UpToDate content on etiology of hypertension in children and adolescents.