MALIGNANT HYPERTENSION IN CHILDREN IN INDIA

Background. Malignant hypertension is now an uncommon entity in the we stern world but still remains a significant problem in India. Therefor e we studied the aetiological spectrum, management, and outcome of the se patients. Methods. Forty consecutive children (<16 years) with mali gnant hypertension were admitted and investigated to exclude or confir m the secondary causes of hypertension. For acute control of blood pre ssure sublingual nifedipine was used in dosage of 0.3-0.6 mg/kg, faili ng which intravenous nitroglycerin was used. In patients with aortoart eritis with active disease, steroids were used. Angioplasty was carrie d out for renal artery stenosis whenever possible. Results. Renoparenc hymal disease was the commonest cause of malignant hypertension, and w as seen in 25 cases, renovascular hypertension in 13 cases (11 aortoar teritis and two fibromuscular dysplasia), and two had essential hypert ension. For acute control of severe hypertension, sublingual nifedipin e was effective in 92.5% of patients. Of the patients with renoparench ymal disease five became normotensive with treatment of the underlying disease, four received renal allograft, seven died, and nine are stab le on antihypertensive drugs. Renal angioplasty was carried out in sev en patients with renovascular hypertension (4 cured, 3 improved) and s ix are controlled on drugs. Conclusions. We conclude that apart from r enoparenchymal disease, aortoarteritis is a common cause of malignant hypertension in children. Sublingual nifedipine is effective for the r apid control of severe hypertension, and angioplasty is effective in a ortoarteritis for short-term preservation of renal function and contro l of hypertension.