DOI: 10.36347/sajb.2018.v06i01.011

Pages: 84-89

Hypertensive emergencies (HTE) in children are relatively rare but life threatening medical emergency. Objectives of the present study were: 1) Find out the incidence, etiology and clinical presentation of HTE 2) Assess real burden of primary hypertension among HTE. A total of 26 children with HTE were studied and the incidence of Hypertension (HTN) was 0.9% while incidence of Hypertensive crisis (HTC) and HTE was 0.5% and 0.3% respectively. Cases were divided into four age groups: infants (< 1 year of age); preschool age (1 to 6 years of age); school going age (6 to 12 years of age); and adolescents (13 to 18 years of age). Adolescents (43%) and school going children (36%) were mostly affected. Male to female ratio was 2.5:1. Primary HTN was noticed in 21% while secondary HTN in 79%. Primary HTN was observed in adolescents (33%) and school going children (20%). All patients presented with Stage 2 HTN. Among secondary HTN 68% patients had intrinsic renal disease as the cause of HTE. Among these, 68% had Glomerulonephritis, 16% obstructive uropathy, 11% reflux nephropathy and 5% Hemolytic uremic syndrome. Apart from renal causes 7% had renovascular, 4% endocrine/oncological as the cause of HTE. In infancy coarctation of aorta was the most common cause of HTE. In preschool, school going and adolescent age groups intrinsic renal disease was the most common cause of HTE followed by renovascular and endocrine causes. Clinical features observed were: dizziness (32%), head ache (29%), nausea and vomiting (29%), chest discomfort (21%), altered sensorium (21%), visual blurring (21%) and convulsions (14%) apart from disease specific symptoms. All patients had end organ damage. Study revealed increasing incidence of primary HTN as a cause of HTE in young school going children though the secondary HTN is still more common and more serious at presentation.