Dr. Wafaa Ibrahim Abugabal
Ministry of health, Egypt
Abstract Title:
Beyond Shock: Why We Miss Hypertension in Critically Ill Children
Biography:
Dr. Wafaa Ibrahim Abugabal, MD, IBCLC, is a Pediatric Intensive Care Consultant and Head of Pediatrics and the Pediatric Intensive Care Unit at Manshiet El Bakry Hospital, Ministry of Health, Egypt. She earned her Doctorate in Pediatrics from Ain Shams University and has extensive experience in pediatric intensive care, emergency medicine, neonatal care, and postoperative cardiac critical care. A dedicated medical educator, Dr. Wafaa serves as a trainer for the Egyptian Board and Fellowship programs and has led numerous educational initiatives in pediatric critical care, simulation-based training, and patient safety. An International Board Certified Lactation Consultant (IBCLC), she is committed to advancing evidence-based pediatric practice, quality improvement, and multidisciplinary collaboration to improve outcomes for critically ill children.
Research Interests:
Background: Hypertension in critically ill children remains an underrecognized yet clinically significant problem in the Pediatric Intensive Care Unit (PICU). While substantial attention is devoted to identifying and treating hypotension and shock, elevated blood pressure is frequently overlooked despite its association with acute neurological, cardiovascular, and renal complications. Multiple factors contribute to hypertension in critically ill children, including acute kidney injury, chronic kidney disease, fluid overload, pain, agitation, corticosteroid exposure, vasoactive medications, and neurological insults.
Objective: To highlight the epidemiology, causes, diagnostic challenges, and management implications of hypertension in critically ill children and emphasize the importance of incorporating systematic blood pressure assessment into routine PICU practice.
Methods: A narrative review of contemporary literature was conducted focusing on pediatric hypertension, hypertensive crises, and blood pressure management in critically ill children. Current evidence regarding risk factors, clinical consequences, recognition barriers, and therapeutic approaches was reviewed.
Results: Hypertension is common in critically ill pediatric patients and is often multifactorial. Despite its prevalence, delayed recognition remains frequent because clinical attention is typically directed toward hemodynamic instability and shock. Uncontrolled hypertension may lead to hypertensive encephalopathy, seizures, cardiac dysfunction, retinal injury, and worsening renal impairment. Early identification through accurate blood pressure measurement and recognition of age-specific thresholds allows timely intervention and reduction of target-organ injury. Management should focus on treating the underlying cause while implementing individualized antihypertensive therapy when indicated.
Conclusion: Hypertension should no longer be considered a secondary concern in pediatric critical care. Recognizing elevated blood pressure as an important marker of disease severity and potential end-organ injury may improve outcomes in critically ill children. Increased awareness, structured monitoring protocols, and prompt intervention are essential to ensure that hypertension does not remain the forgotten vital sign in the PICU.
