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Treatment of hypertensive crisis in children with nifedipine
J Lopez-Herce1, L Albajara, P Cagigas
1Unidad de Cuidados Intensivos Pediatricos, Hospital Infantil la Paz, Madrid, Spain.
Insights
Sublingual nifedipine effectively manages hypertensive crises in children. Dosages are weight-based, with significant blood pressure reduction observed within minutes, lasting for hours with no reported side effects.
Area of Science:
- Pediatric Cardiology
- Pharmacology
Background:
- Hypertensive crises in children require prompt and effective management.
- Sublingual nifedipine is a potential treatment option for pediatric hypertension.
Purpose of the Study:
- To evaluate the efficacy and safety of sublingual nifedipine in treating hypertensive crises in children.
- To determine optimal weight-based dosages for sublingual nifedipine administration.
Main Methods:
- Retrospective analysis of 31 pediatric cases with hypertensive crises.
- Administration of weight-based sublingual nifedipine dosages (2.5 mg, 5 mg, or 10 mg).
- Monitoring of blood pressure changes, onset, and duration of nifedipine's effect.
Main Results:
- Sublingual nifedipine significantly reduced systolic and diastolic blood pressure in children.
- Blood pressure decreased within 5 minutes, with maximum reduction at 60 minutes, persisting for 180 minutes.
- Nifedipine showed a greater effect on diastolic than systolic pressure, with no observed adverse effects.
Conclusions:
- Weight-based sublingual nifedipine is a safe and effective treatment for hypertensive crises in pediatric patients.
- The medication demonstrates rapid onset and sustained blood pressure-lowering effects.
- Further research may explore long-term outcomes and optimal dosing strategies.
Abstract:
We report 31 episodes of hypertensive crises in children, managed with sublingual nifedipine at the following dosages: 10 mg in children with body weight (BW) higher than 20 kg, 5 mg in children with BW between 10 and 20 kg, and 2.5 mg in children with BW below 10 kg. The mean initial blood pressures were 161.41 mm Hg for the systolic pressure (mSBP) and 111.25 mm Hg for the diastolic pressure (mDBP). After nifedipine, both the mSBP and the mDBP decreased, with onset of effect five minutes after dosage and maximum decrease at 60 min (mSBP 134.93 mm Hg, mDBP 79.23 mm Hg, for decreases of 16.4 and 28.7%, respectively), and this effect persisted for 180 min. Blood pressure increased again from min 240 to min 360, yet without reaching the initial levels. One case did not respond to the first dose of nifedipine and required a second one. The effect of nifedipine was more pronounced on the DBP than on the SBP, and greater reductions of both pressures were achieved in the cases with higher initial readings. No side of medication were observed in our patients.