Sodium nitroprusside treatment of severe arterial hypertension in children

Severe arterial hypertension in children constitutes a high-risk situation requiring rapid and effective therapy. We have assessed the clinical value of sodium nitroprusside as a rapidly acting antihypertensive agent. Twenty children admitted with hypertensive crises of renal origin were treated with intravenous infusion of sodium nitroprusside at an average rate of 1.4 mug/kg/min. Desired levels of blood pressure were reached in all patients within one to 20 minutes. Rapid improvement of cardiac failure was observed in all patients, and neurologic signs of distress disappeared in 16 of the 20 children within 24 to 48 hours of treatment, permitting substitution of oral medication. One patient died of cerebral hemorrhage without improvement of encephalopathy. There were no undesirable effects of therapy or deterioration of renal function in any patient.