Isradipine for treatment of acute hypertension in hospitalized children and adolescents.

Author(s): Miyashita Y, Peterson D, Rees JM, Flynn JT

Affiliation(s): Division of Nephrology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 15224, USA. yosuke.miyashita@chp.edu

Publication date & source: 2010-11, J Clin Hypertens (Greenwich)., 12(11):850-5.

Publication type: Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Severe acute hypertension in pediatric patients requires prompt and controlled blood pressure (BP) reduction to prevent end-organ damage. The authors aimed to examine the efficacy and safety of isradipine, an orally administered second-generation dihydropyridine calcium channel blocker, for treatment of acute hypertension in hospitalized pediatric patients. A retrospective analysis of 391 doses of isradipine administered to 282 patients (58% boys) with acute hypertension and median age of 12.8 years (range, 0.1-21.9) was performed. Primary diagnoses included renal disease (n=154), malignancy (45), nonrenal transplant (37), neurologic disease (21), and other (25). The decrease in systolic BP was 16.3%+/-11.6% (mean +/- SD) and diastolic BP was 24.2%+/-17.2%. BPs were significantly lower in all age groups and in all diagnosis categories following isradipine administration. The decrease in BP was the highest in children younger than 2 years. The mean increase in pulse after a dose was 7+/-17 beats per minute. Forty adverse events were reported in 33 patients, with emesis and nausea being the most common; 5 of these events were hypotension. The authors conclude that isradipine effectively reduces BP in a wide variety of hospitalized children and adolescents with acute hypertension. A lower initial dose of 0.05 mg/kg may be appropriate in children younger than 2 years. (c) 2010 Wiley Periodicals, Inc.