Intravenous nicardipine for treatment of severe hypertension in children

Objective: To examine the effect of intravenous nicardipine in the treatment of children with severe hypertension. Methods: The medical records of 29 children (mean age 94 months) treated with :intravenous nicardipine were retrospectively reviewed. The mean duration 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 +/- SD). 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 nicardipine was started. Nicardipine treatment produced a 16% reduction in systolic blood pressure, a 23% reduction in diastolic blood pressure, and a 7% increase in heart rare. Nicardipine was effective as a single agent on 26 (84%) of 31 occasions. Adverse effects included tachycardia, Rushing, palpitations, and hypotension. Conclusions: When administered in the intensive care unit setting with close patient monitoring, intravenous nicardipine effectively lowered blood pressure in children with severe hypertension. Larger prospective studies should be conducted to confirm these findings.