Nifedipine and captopril in hypertensive crisis in children.

Abstract

Introduction: Hypertensive crisis is a pediatric emergency which implies medications with fast action and minimal side effects. Sodium nitroprusiate in continuous infusion has been the treatment of choice but implicates admission to intensive care unit.

Objectives: To evaluate efficacy and safety of nifedipine and captopril in hypertensive crisis in children.

Methodology: A prospective study was performed to evaluate efficacy and safety of sublingual nifedipine and captopril, in children 1-12 years old who were admitted with diagnosis of hypertensive crisis, to the Pediatric Emergency Service at the University Hospital in Cali, Colombia. Systolic, diastolic, mean blood pressure and heart rate were monitored in all patients before administration of the medicaments, time 0, and after the administration at time 5, 15, 30, 60, 120, 180, 240, 300, and 360 minutes. Side effects were observed carefully after the administration.

Results: During a period of 16 months, 21 patients were enrolled in the study: 10 were assigned to nifedipine and 11 to captopril; 13 were boys and 8 were girls, with a mean age of 7 years old. Both medications were given sublingual at 0.2mg/kg/dose. Blood pressure reduction under 95 percentil induced by sublingual nifedipine was faster, mean time 20 minutes compared to captopril (50 minutes). Up to 30 minutes post medication systolic, diastolic and mean blood pressure were statistically lower with nifedipine than with captopril; but after 30 minutes both medications had similar activity. Three patients with Nifedipine and 1 with captopril required a second dose. Two patients with captopril had no response. No side effects were registered in either group. Nifedipine induced a 10% asymptomatic heart rate increase at 5 minutes after its administration, captopril did not increase heart rate.

Conclusions: Both medications nifedipine and captopril are safe, efficacious and easy to administer in hypertensive crisis in children; the effect lasts for 6 hours. Nifedipine induced a faster response, captopril presented a slower but sustained response.