Intravenous Hydralazine in Hospitalized Children and Adolescents with Hypertension

Area of Science:

• Pediatric Nephrology
• Pediatric Cardiology
• Clinical Pharmacology

Background:

• Hypertension in hospitalized children is a significant clinical concern.
• Intravenous (IV) hydralazine is a commonly used agent for managing acute hypertension in pediatric populations.
• Understanding the efficacy and safety profile of IV hydralazine in children is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate the effectiveness of IV hydralazine in reducing blood pressure (BP) in hospitalized children.
• To assess the safety of IV hydralazine, including the incidence of adverse events.
• To identify factors associated with ideal BP response and excessive BP reduction.

Main Methods:

• Retrospective data collection from hospitalized children treated with IV hydralazine.
• Calculation of percent changes in blood pressure (BP) and mean arterial pressure (MAP).
• Use of linear and bivariate logistic regression to analyze associations between BP changes, clinical variables, and response outcomes (ideal clinical response and excess response).

Main Results:

• A total of 141 IV hydralazine doses were analyzed in children (median age 8 years), many with underlying renal disease, malignancy, or post-transplant status.
• The mean reduction in MAP was 19% ± 12%, with an ideal clinical response (10%-25% MAP reduction) in 47% of patients.
• Excessive response (>25% MAP reduction) occurred in 31% of children; higher initial MAP and hydralazine dose were associated with both ideal and excessive responses.

Conclusions:

• IV hydralazine demonstrates efficacy in reducing BP in the majority of hospitalized pediatric patients.
• A notable proportion of children experienced excessive BP reduction, highlighting the need for cautious administration and monitoring.
• Further research may be warranted to refine dosing guidelines and identify predictors of response in diverse pediatric populations.