Advances in the management of severe arterial hypertension

: This article deals with current concepts about severe hypertension. This is defined by recorded values of more than 20 mmHg above the 97th percentile for weight and height. Exceptionally it is asymptomatic, abut most of the time presents with signs of hypertensive encephalopathy and/or hypertensive cardiopathy, cardiac failure and/or acute pulmonary edema. The most frequent causes in the Hospital Infantil de Mexico Federico Gomez were: diffuse acute glomerulonephritis, segmental renal hypoplasia, renovascular hypertension and end-stage renal disease. First of all, on admission in the emergency room, the hypertensive child must be treated with rapid-acting drugs such as calcium channel blockers, sodium nitroprusside or diazoxide. Secondly, quick laboratory examinations as urinalysis, serum electrolytes and BUN must be performed to elaborate a presumptive diagnosis, in order to choice a therapy upon the pathophysiology. According to this thought, furosemide administration is mandatory in acute glomerulonephritis and could be supported by nifedipine. In renal hypoplasia and in renovascular hypertension the use of convertase enzyme inhibitors is indicated in the first place and may be supported by propranolol and/or diuretics. Finally, in hypertension due to end-stage renal disease, peritoneal dialysis with hypertonic solutions or ultrafiltration in chronic hemodialysis program are usually needed.