Neonatal hypertension: focus on diagnosis and therapy

This study aimed to analyze and summarize the recent literature on the diagnosis and management approach of arterial hypertension in the newborn infant. Neonatal hypertension is a rare condition, with its incidence ranging from 0.2% to 3%. It is affected by several factors, with gestational age, post-conceptual age and birthweight having the strongest impact. Hypertension in the neonatal population is almost always secondary. The two major causes of neonatal hypertension are renovascular and renal parenchymal diseases, which account for 25% to 50% of all cases of hypertension in the Neonatal Intensive Care Unit (NICU). Usually, the symptoms are nonspecific, and hypertension is disclosed on routine monitoring of the newborn vital signs. Clinical history, physical examination, prior laboratory data, and prenatal scans are frequently enough to establish the underlying cause of hypertension. The majority of treatment protocols are based on case reports and experts experience and opinion, due to the lack of clinical trials evaluating the efficacy and safety of antihypertensive drugs in the neonatal population. However, most classes of antihypertensive drugs have been used in this age group, such as direct vasodilators, angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic blockers, calcium channel blockers, and diuretics. Thirty-two percent to 51% of hypertensive neonates are exposed to more than one antihypertensive drug, and the median duration of exposure is 10 days. Vasodilators are the most commonly used class of antihypertensive used in the NICU, being hydralazine the most frequent of all.