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Convulsions and hypertension in children: differentiating cause from effect
F Proulx1, J Lacroix, C A Farrell
1Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Canada.
Critical Care Medicine
|October 1, 1993
Summary
Blood pressure elevation can indicate hypertensive crisis or seizures. A blood pressure reading 4 standard deviations above the mean in postictal patients strongly suggests hypertensive crisis requiring treatment.
Area of Science:
- Pediatric Intensive Care
- Neurology
- Cardiology
Background:
- Hypertensive crisis and seizures can both cause elevated blood pressure (BP) in children.
- Differentiating the cause of BP elevation is crucial for appropriate management.
Purpose of the Study:
- To determine if the magnitude of BP increase can distinguish between convulsions due to hypertensive crisis and those from primary convulsive disorders.
Main Methods:
- Retrospective analysis of children admitted to a pediatric intensive care unit.
- Comparison of BP in children with hypertensive crisis versus those with status epilepticus.
Main Results:
- Children in hypertensive crisis had significantly higher BP Z scores than those with status epilepticus (p < .0001).
- A postictal BP of ≥4.0 SD above the mean predicted hypertensive crisis with 78% probability.
- A postictal BP <4.0 SD below the mean excluded hypertensive crisis with 100% negative predictive value.
Conclusions:
- Both hypertensive crisis and status epilepticus can present with high BP in children.
- The magnitude of BP increase is a valuable clinical parameter to exclude hypertensive crisis in postictal patients.