Hypertensive emergency
Paediatric emergency management · Nephrology · Emergency
Severe hypertension with acute end-organ injury (encephalopathy, seizures, heart failure, retinopathy, AKI). Confirm with a correctly sized cuff; obtain access and continuous BP monitoring, ideally an arterial line.
Principle — lower BP gradually
- Reduce BP by no more than about 25% of the planned total reduction in the first 8 h, then normalise over 24–48 h.
- Too-rapid reduction risks cerebral, retinal and renal ischaemia.
- Treat seizures; manage fluid overload; find and treat the cause (renal is commonest in children).
Common questions
What is the first step in hypertensive emergency?
Severe hypertension with acute end-organ injury (encephalopathy, seizures, heart failure, retinopathy, AKI). Confirm with a correctly sized cuff; obtain access and continuous BP monitoring, ideally an arterial line.
What drug doses are used in hypertensive emergency?
Labetalol: Bolus 0.2–1 mg/kg IV (max 40 mg); then infusion 0.25–3 mg/kg/h. Nicardipine infusion: 0.5–3 mcg/kg/min IV, titrated to effect. Sodium nitroprusside infusion: 0.5–8 mcg/kg/min IV (monitor for cyanide with prolonged use).
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.