Advances in the pathogenesis and management of hypertensive crisis

This review summarizes recent insights into to the pathophysiology of hypertensive crisis with the emphasis on newly discovered molecular mechanisms underlying hypertension and also updates current therapeutic options for treating hypertensive crisis in children.There is growing evidence that the renin-angiotensin system plays a key role in the pathogenesis of hypertensive crises. Recent studies have shown that oxidative stress and factors affecting endothelial function are also important. Treatment of hypertensive crisis still focuses on lowering of blood pressure in an expeditious but safe manner. There is growing experience with IV nicardipine, which is becoming a viable alternative to sodium nitroprusside in children.Current knowledge of hypertensive crisis emphasizes the need for additional animal and translational studies with the goal of identifying the underlying molecular pathogenesis and developing new therapies to optimize future treatment of hypertensive emergencies.