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Antihypertensive(s) and/or Lifestyle Modifications

Initial BP lowering medication



Initial dose

Titration frequency

Maximal dose

How supplied


0.1 mg/kg (up to 2.5 mg) once daily

Every 3-5 days

0.3 mg/kg (up to 10 mg) once daily

Tablet: 2.5, 5 and 10 mg

Ex temporeneous: 1 mg/mL

*consider enalapril if patient has concomitant diabetes mellitus

Rescue medications





Nifedipine immediate release


0.25 mg/kg (max 5 mg) every 4-6 hours for severe BR elevations^. May increase to 0.5 mg/kg (max 10 mg) if inedequate response to lower dose



0.1 mg/kg (up to 20 mg) every 4-6 hours for severe BP elevations^. May increase to 0.2 mg/kg (max 40 mg) if inadequate response to lower dose

^severe BP elevation means a BP consistently ≥ 99th percentile

Consult Nephrology if ≥ 2 doeses in 24 hours required to normalize BP

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.