Acute Severe Hypertension in Children: An Ongoing Search for Therapeutic Agent of Choice

Facial paralysis was first described in a hypertensive patient by Moxon1 more than a century ago. Subsequently, there have been reports2-8 that have included a number of children, and facial palsy is mentioned in standard pediatric references9,10 as a rare feature of hypertension. Even so, practitioners may fail to recognize that facial (seventh cranial nerve) paralysis can be the initial feature of severe hypertension in children. To increase the level of awareness, we describe three severely hypertensive children who were first seen with facial paralysis between 1980 and 1988. In one of these children the diagnosis of hypertension was delayed.

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Hypertension as a Cause of Facial Paralysis

PEDIATRICS ◽

10.1542/peds.50.1.171 ◽

1972 ◽

Vol 50 (1) ◽

pp. 171-171

Author(s):

Saul D. Roskes

Keyword(s):

Differential Diagnosis ◽

Facial Paralysis ◽

Review Paper ◽

Severe Hypertension ◽

Facial Canal ◽

Peripheral Facial Paralysis ◽

Initial Manifestation ◽

High Level ◽

Hypertension In Children

The review paper by Drs. Manning and Adour on facial paralysis in childhood was illuminating in terms of differential diagnosis. However, one very important consideration in the assessment of children who present with peripheral facial paralysis is the possibility that it may be the initial manifestation of severe hypertension in children. It is presumed that the paralysis is due to hemorrhage within the facial canal. Because hypertension in childhood very frequently has an etiology which is surgically or medically remediable the index of suspicion for its presence must be maintained at a high level.

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Haemodynamic Effects of a Calcium Antagonistic Agent (Nifedipine) in Hypertension: Therapeutic Implications

Clinical Science ◽

10.1042/cs055291s ◽

1978 ◽

Vol 55 (s4) ◽

pp. 291s-292s ◽

Cited By ~ 8

Author(s):

C. Bartorelli ◽

F. Magrini ◽

P. Moruzzi ◽

M. T. Olivari ◽

A. Polese ◽

...

Keyword(s):

Therapeutic Agent ◽

Severe Hypertension ◽

Hypertensive Crisis ◽

Rapid Onset ◽

Left Ventricular ◽

Critical Conditions ◽

Ventricular Failure ◽

Onset Of Action ◽

Therapeutic Implications ◽

Pulmonary Arterial

1. In 27 severe primary hypertensive patients nifedipine (10 mg), administered orally, induced prompt (–21% of control at 30 min) and persistent (–17% at 120 min) fall of mean arterial pressure mediated through reduction of peripheral vascular resistance with rise of cardiac output. 2. The sublingual route (nine cases) showed more rapid onset of action and equal antihypertensive effectiveness. 3. In five patients with hypertensive crisis and acute left ventricular failure, the drug strikingly reduced systemic and pulmonary arterial pressures and relieved pulmonary oedema. 4. Prompt efficacy, ease of administration, absence of important side effects indicate that nifedipine may be a useful therapeutic agent in severe hypertension and in critical conditions that require rapid lowering of blood pressure.

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