Clinical Characteristics and Outcomes of Children with Hypertensive Encephalopathy

Background Hypertensive encephalopathy (HE) is characterized by a severe increase in blood pressure, leading to neurological symptoms such as severe headache, seizure, and mental status change. The underlying pathophysiology includes a disruption of the cerebral endothelium and blood-brain barrier, leading to cerebral edema and microhemorrhages. Prompt medical treatment is crucial, often leading to full recovery without long-term neurological deficits. However, untreated cases can result in serious complications. This study aimed to describe the clinical characteristics and outcomes of children who developed HE. Materials and Methods A retrospective review of medical records in patients aged < 20 years diagnosed with HE in Ramathibodi Hospital was conducted. Data were collected, including demographics, underlying conditions, clinical presentations, blood pressure levels during HE, medication use, diagnostic investigations, and outcomes. Patients with pre-existing neurological symptoms or incomplete data were excluded. Data between the groups with kidney diseases and non-kidney diseases were compared. Results Fifty-three patients (26 males) were included with a mean age of 8.9 ± 4 years and a median follow-up time of 47.8 months. Kidney disease (51%) was the most common cause of hypertension. Patients with kidney disease were older (10.3 vs. 7.5 years, p  = 0.01), had a shorter duration between the diagnosis of underlying conditions and development of HE (70 vs. 457 days, p  = 0.04), and a larger proportion of females (66.7% vs. 34.6%, p  = 0.02). Neither clinical manifestations such as generalized tonic-clonic seizures, headaches, and mental status changes nor survival were different between the kidney and non-kidney groups. Five patients developed recurrent episodes of HE. The recurrent group had a higher proportion of patients with underlying diseases involving endothelial injuries, such as small vessel vasculitis and calcineurin inhibitors used in post-hematopoietic stem cell transplantation (HSCT) (100% vs. 35.4%, p  = 0.009) than the non-recurrent groups. Conclusions Patients with kidney diseases were older and developed HE earlier, but there was no difference in survival between the kidney and non-kidney groups. The group with recurrent episodes of HE was more commonly detected in patients with small vessel vasculitis and calcineurin inhibitors used in post-HSCT, prompting the pediatricians to be vigilant for blood pressure control in these patients. Clinical trial number : not applicable