UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Hypertension in the ED

Keywords: Hypertension, HUS, Coarctation, renal disease (PubMed Search)

Posted: 3/28/2008 by Sean Fox, MD (Updated: 7/11/2020)
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  • Normative BP values are based on Age, Sex, and Height (check Harriet-Lane).
  • BP should be measured in all children >3yrs and in selected children <3yrs.
  • The younger the child and the higher the BP, the more likely there is a secondary cause. 
  • Most common secondary causes:
    • 1st year of life: RenoVascular anomalies and aortic coarctation.
    • Early childhood/school-aged kids: Renal Parenchymal Disease
    • Adolescents: Essential hypertension
  • 25% of children that present with HTN requiring emergent management present with hypertensive encephalopathy (ie.  it is a more common presentation of HTN in pediatrics than in adults).
  • Initial Work-up:
    • Upper and Lower Extremity BP measurement
    • BMP and U/A – look for renal disease
    • CBC – microangiopathic process c/w HUS?



Belsha, CW. Pediatric hypertension in the emergency department. Ann Emerg Med. 2008 Mar;51(3 Suppl):S21-3. Epub 2008 Jan 11.