TABLE 10.

Antihypertensive Drugs for Management of Severe Hypertension in Children 1–17 Years Old

DrugClassDose*RouteComments
Most useful
    Esmololβ-Blocker100–500 μg/kg per minIV infusionVery short-acting; constant infusion preferred. May cause profound bradycardia. Produced modest reductions in BP in a pediatric clinical trial.
    HydralazineVasodilator0.2–0.6 mg/kg per doseIV, IMShould be given every 4 h when given IV bolus. Recommended dose is lower than FDA label.
    Labetalolα- and β-BlockerBolus: 0.2–1.0 mg/kg per dose up to 40 mg/dose Infusion: 0.25–3.0 mg/kg per hIV bolus or infusionAsthma and overt heart failure are relative contraindications.
    NicardipineCalcium channel blocker1–3 μg/kg per minIV infusionMay cause reflex tachycardia.
    Sodium nitroprussideVasodilator0.53–10 μg/kg per minIV infusionMonitor cyanide levels with prolonged (>72 h) use or in renal failure; or coadminister with sodium thiosulfate.
Occasionally useful
    ClonidineCentral α-agonist0.05–0.1 mg/dose, may be repeated up to 0.8 mg total dosepoSide effects include dry mouth and sedation.
    EnalaprilatACE inhibitor0.05–0.1 mg/kg per dose up to 1.25 mg/doseIV bolusMay cause prolonged hypotension and acute renal failure, especially in neonates.
    FenoldopamDopamine receptor agonist0.2–0.8 μg/kg per minIV infusionProduced modest reductions in BP in a pediatric clinical trial in patients up to 12 years
    IsradipineCalcium channel blocker0.05–0.1 mg/kg per dosepoStable suspension can be compounded.
    MinoxidilVasodilator0.1–0.2 mg/kg per dosepoMost potent oral vasodilator, long-acting.
  • FDA indicates Food and Drug Administration; IM, intramuscular; IV, intravenous; po, oral.

  • * All dosing recommendations are based on expert opinion or case series data except as otherwise noted.

  • Useful for hypertensive emergencies and some hypertensive urgencies.

  • Useful for hypertensive urgencies and some hypertensive emergencies.