Intravenous nicardipine for treatment of severe hypertension in children

Objective: To examine the effect of intravenous nicardipine in the treatmen t of children with severe hypertension. Methods: The medical records of 29 children (mean age 94 months) treated wi th :intravenous nicardipine were retrospectively reviewed. The mean duratio n of severe hypertension before nicardipine use was 12.5 hours. Most (74%) patients were receiving other antihypertensive agents before nicardipine. Results: The initial nicardipine dose was 0.8 +/-0.3 mug/kg/min (mean +/- S D). The mean effective dose was 1.8 +/-1.0 mug/kg/min (range, 0.3 to 4.0). Blood pressure control was achieved within 2.7 +/-2.1 hours after nicardipi ne was started. Nicardipine treatment produced a 16% reduction in systolic blood pressure, a 23% reduction in diastolic blood pressure, and a 7% incre ase in heart rare. Nicardipine was effective as a single agent on 26 (84%) of 31 occasions. Adverse effects included tachycardia, Rushing, palpitation s, and hypotension. Conclusions: When administered in the intensive care unit setting with clos e patient monitoring, intravenous nicardipine effectively lowered blood pre ssure in children with severe hypertension. Larger prospective studies shou ld be conducted to confirm these findings.