Evaluation of Systemic Hypertension in a Tertiary Pediatric Intensive Care Unit

Background: Hypertension in pediatric intensive care unit (PICU) is common and contributes to morbidity and mortality. Management differs on the basis of underlying diseases.

Objective: To evaluate systemic hypertension requiring treatment in tertiary PICU.

Methods: We used a database generated from the electronic health records of patients, admitted to PICU, between November 2018 and November 2020, retrospectively. We identifed children with hypertension requiring medications for hypertension. Blood pressure (BP) measured every hour by an oscillometric method using appropriate size cuff. Hypertension was diagnosed when at least three separate measurements of systolic and/or diastolic BP greater than the 95th percentile (based upon sex and age) over one day and treated according to 2017 AAP guideline. Patients with transient high BP requiring intravenous or intermittent oral medications were excluded. We collected data on etiology, medication, echocardiogram and renal ultrasound reports. We did not evaluate furosemide as an anti-hypertensive drug.

Results: During the study period, 600 children were admitted. We identified 47 (7.8%) children requiring chronic medications for persistently elevated BP. Mortality rate 30% (n:18/59) in patients with treated hypertension. Five children excluded. For medical treatment used oral medications included amlodipine, captopril, enalapril and thiazide diuretics, losartan, propronolol as a second agent. 11 patients were using medication before admission. Multiple drugs were needed simultaneously to control BP in 35 (74.4%). Renal ultrasound was abnormal in 20 (42.5%), and included: increased echogenicity (12), hydronephrosis (4), cystic kidneys (2), nephrocalsinosis (1), renal trombosis (1). A sydrome was identified in 14 (29.7%). Increased intracranial pressure was identifed in 8 (17%). Echocardiographic finding was detected in only one.

Conclusion: The risk factors for treated hypetension were multifactorial and most children had more than one etiology. Renal disease was the most common risk factor. Monitoring of BP and renal function, serial imaging should be performed.