Peds Hypertension

Hypertensive urgencies and emergencies can be missed in kids when physicians are used to the elevated BP’s of adults with essential hypertension. Hypertension in children is defined relative to the 95^th percentile for age & sex. BP > 90^th percentile is elevated; Stage 1 hypertension is a BP from the 95^th percentile to 95^th + 12 mm Hg. Stage 2 hypertension is a BP > the 95^th percentile + 12 mm Hg (or > 140/90 for > 13yo). Stage 1 and asymptomatic Stage 2 patients should be referred back to the PMD for confirmation of repeated elevated BPs and outpatient work-up. Hypertensive emergency is a Stage 2 patient with evidence of end-organ damage, e.g. seizure, stroke, altered mental status, papilledema, heart failure, or a BP > the 95^th percentile + 30 mm Hg, even if asymptomatic. Charts can be used to determine the 90^th and 95^th percentile, but a rule of thumb is that 95 + 2 (age in yrs)/50 + 2 (age in yrs) = the 90^th percentile, and 115 + 2 (age in yrs)/65 + 2 (age in yrs) = Stage 2 hypertension. (Source: MacNeill E. Pediatric Emergency Medicine Practice, March 2019)