CONVULSIONS AND HYPERTENSION IN CHILDREN - DIFFERENTIATING CAUSE FROMEFFECT

Objective. To determine if the magnitude of blood pressure (BP) increa se could differentiate convulsion caused by a hypertensive crisis from a primary convulsive disorder, which itself increases BP. Design: Ret rospective analysis. Setting. Admission to a pediatric intensive care unit (ICU) within a tertiary care center. Patients. All children with hypertensive crisis admitted to the pediatric ICU from 1976 to 1990 we re studied. Thirty-eight episodes occurred in 36 patients. The charts of children admitted for status epilepticus from 1976 to 1986 were als o reviewed. One hundred and fifty-three episodes occurred in 145 patie nts.Measurements and Main Results: BP values at entry to the pediatric ICU in patients with hypertensive crisis were compared with the highe st BP values obtained within an hour after cessation of convulsion in 120 patients admitted for status epilepticus. The Z scores for BP, adj usted for age and sex, were compared. The BP values for children in hy pertensive crisis with or without convulsions were by far greater than the BP values observed in patients in status epilepticus (p < .0001). For a patient in the postictal phase, a BP greater-than-or-equal-to 4 .0 SD above the mean for age and sex predicted with 78% probability th e presence of a hypertensive crisis requiring emergency treatment. If the BP was < 4 SD below the mean, the possibility of a hypertensive cr isis was excluded (negative-predictive value 100%). Conclusions: Child ren with hypertensive crisis, as well as children with status epilepti cus, can present with a high BP. In a postictal patient, the magnitude of BP increase is a useful clinical parameter to exclude a hypertensi ve crisis that requires specific treatment of the BP.