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The management of hypertensive emergencies in children after stem cell transplantation

D G Horn1, M N Trame, G Hempel

  • 1Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Münster, Germany.

International Journal of Clinical Pharmacy
|March 12, 2011
PubMed

Insights

Treatment for pediatric hypertensive emergencies, especially post-stem cell transplant, lacks robust clinical trials. Current practices rely on physician experience, with nicardipine as a potential first choice despite limited pediatric data.

Area of Science:

  • Pediatric Nephrology
  • Pharmacology
  • Hematology/Oncology

Background:

  • Hypertensive emergencies in children, particularly after stem cell transplantation, often stem from calcineurin inhibitor use.
  • These emergencies necessitate prompt intervention to prevent end-organ damage.

Purpose of the Study:

  • To review available data on drugs for pediatric hypertensive emergencies.
  • To focus on treatment strategies following stem cell transplantation.

Main Methods:

  • Literature search using MEDLINE and PubMed.
  • Keywords included: hypertensive emergencies, nifedipine, nicardipine, children.
  • Cross-referencing of identified articles and books.

Main Results:

  • Pediatric use of hypotensive agents is largely experience-based, not trial-driven.
  • Calcium channel blockers may offer benefits due to mechanism and potential nephroprotection.
  • Intravenous nifedipine use in children is questionable due to side effects and limited data; nicardipine is a preferred agent but lacks adequate pediatric safety data.

Conclusions:

  • Current treatment for pediatric hypertensive emergencies lacks strong scientific evidence.
  • Treatment choices should consider drug properties, side effects, limited experience, and patient history.
Abstract

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