Malignant hypertension in children in India

BACKGROUND: Malignant hypertension is now an uncommon entity in the westernworld but still remains a significant problem in India. Thereforewe studied the aetiological spectrum, management, and outcomeof these patients. METHODS: Forty consecutive children (<16 years) with malignant hypertensionwere admitted and investigated to exclude or confirm the secondarycauses of hypertension. For acute control of blood pressuresublingual nifedipine was used in dosage of 0.3–0.6 mg/kg,failing which intravenous nitroglycerin was used. In patientswith aortoarteritis with active disease, steroids were used.Angioplasty was carried out for renal artery stenosis wheneverpossible. RESULTS: Renoparenchymal disease was the commonest cause of malignanthypertension, and was seen in 25 cases, renovascular hypertensionin 13 cases (11 aortoarteritis and two fibromuscular dysplasia),and two had essential hypertension. For acute control of severehypertension, sublingual nifedipine was effective in 92.5% ofpatients. Of the patients with renoparenchymal disease fivebecame normotensive with treatment of the underlying disease,four received renal allograft, seven died, and nine are stableon antihypertensive drugs. Renal angioplasty was carried outin seven patients with renovascular hypertension (4 cured, 3improved) and six are controlled on drugs. CONCLUSIONS: We conclude that apart from renoparen-chymal disease, aortoarteritisis a common cause of malignant hypertension in children. Sublingualnifedipine is effective for the rapid control of severe hypertension,and angioplasty is effective in aortoarteritis for short-termpreservation of renal function and control of hypertension.