The use of short-acting nifedipine in pediatric patients with hypertension

Objective: To evaluate the use of short-acting nifedipine for treatment of severe hypertension in children. Study design: A retrospective chart review of 520 nifedipine doses given for severe hypertension in 117 pediatric patients was completed. Nifedipine dose, systolic and diastolic blood pressures before and within 2 hours of the dose, and side effects were recorded. Pre- and post-dose mean arterial pressure (MAP) and percent reductions in MAP and systolic and diastolic blood pressure were calculated. Age, dose, primary diagnosis, and use of other antihypertensive agents were examined with respect to blood pressure reduction. Results: Of the doses received, 35% were associated with greater than or equal to 25% reduction in MAP, a degree of MAP reduction previously associated with hypertension treatment complications. MAP percent reduction was correlated with nifedipine dose adjusted for weight (r = 0.24, P <.001). Mean nifedipine doses per kilogram were larger in patients who had <greater than or equal to>25% MAP reduction compared with those who had <25% MAP reduction (0.26<plus/minus>0.12 mg/kg vs 0.21 +/-0.11 mg/kg, F = 29.01, P < .001). Adolescents received lower nifedipine doses per kilogram and had lower percent reduction in blood pressure compared with younger children. No clinically significant side effects were noted after administration of nifedipine. Conclusion: Precipitous reductions in blood pressure are ameliorated by decreasing the initial nifedipine dose to <less than or equal to>0.25 mg/kg in pediatric patients. Short-acting nifedipine use in pediatric patients with hypertension in a hospital setting is safe.