Question

Hypertensive crisis in children: 
Etiopathogenesis. 
 

Hint:

Always evaluate children with hypertensive crisis for secondary causes, particularly renal and endocrine disorders. Early identification and treatment of the underlying condition are essential.

Answer 1

Step 1: Understanding Hypertensive Crisis in Children.
Hypertensive crisis in children is a medical emergency characterized by a significant rise in blood pressure (BP) that leads to end-organ damage. It is defined as systolic BP >180 mmHg or diastolic BP >120 mmHg, although values may vary slightly depending on the age and size of the child.

Step 2: Etiology of Hypertensive Crisis.
Hypertensive crisis can be divided into two types:
1. Hypertensive Urgency: A sudden increase in BP without evidence of acute end-organ damage.
2. Hypertensive Emergency: A rapid and severe increase in BP that causes damage to organs such as the brain, heart, kidneys, or eyes.

Common causes of hypertensive crisis in children include:
1. Secondary hypertension: Due to underlying conditions like renal disease, pheochromocytoma, endocrine disorders (e.g., hyperthyroidism, Cushing's syndrome), or coarctation of the aorta.
2. Essential hypertension: Rare in children, but may occur due to obesity, family history, and poor lifestyle factors.
3. Medication-induced hypertension: Certain medications, such as corticosteroids, stimulants, or oral contraceptives, may contribute to increased BP.
4. Acute illness or trauma: Severe infections, head trauma, or intracranial hemorrhage can trigger hypertensive crisis.

Step 3: Conclusion.
The etiopathogenesis of hypertensive crisis in children often involves secondary causes such as renal disease, endocrine disorders, and medication use. In rare cases, essential hypertension or acute conditions like trauma and infections may contribute.