From the Guidelines
Labile blood pressure can be caused by various factors, including medications, endocrine disorders, neurological conditions, and lifestyle factors, as highlighted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Causes of Labile Blood Pressure
Some common causes of labile blood pressure include:
- Autonomic nervous system dysfunction, which disrupts the body's ability to regulate blood pressure
- Medications such as vasodilators, diuretics, and antihypertensives that may cause rapid changes in blood pressure
- Endocrine disorders like pheochromocytoma (which releases adrenaline unpredictably) or thyroid dysfunction
- Neurological conditions such as stroke or Parkinson's disease
- Emotional stress or anxiety
- Volume depletion from dehydration or blood loss, pain, full bladder, and certain cardiovascular conditions like heart failure or arrhythmias
Lifestyle Factors
Lifestyle factors that can contribute to labile blood pressure include:
- Inconsistent medication adherence
- Variable sodium intake
- Alcohol consumption
- Excessive consumption of caffeine
Management
Management of labile blood pressure typically involves:
- Identifying and treating the underlying cause
- Maintaining consistent medication schedules
- Regular blood pressure monitoring
- Lifestyle modifications including stress reduction techniques, consistent sleep patterns, and moderation of caffeine and alcohol intake, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
From the FDA Drug Label
WARNINGS Withdrawal Patients should be instructed not to discontinue therapy without consulting their physician. Sudden cessation of clonidine treatment has, in some cases, resulted in symptoms such as nervousness, agitation, headache, and tremor accompanied or followed by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma An excessive rise in blood pressure following discontinuation of clonidine hydrochloride tablets therapy can be reversed by administration of oral clonidine hydrochloride or by intravenous phentolamine Because children commonly have gastrointestinal illnesses that lead to vomiting, they may be particularly susceptible to hypertensive episodes resulting from abrupt inability to take medication.
Labile blood pressures can be caused by:
- Sudden cessation of clonidine treatment 2
- Abrupt inability to take medication, especially in children who may experience vomiting due to gastrointestinal illnesses 2
- Withdrawal from clonidine therapy, particularly after administration of higher doses or continuation of concomitant beta-blocker treatment 2
From the Research
Causes of Labile Blood Pressures
- Emotional stress is a common cause of labile hypertension, leading to rapid, temporary rises in blood pressure 3
- White coat hypertension, masked hypertension, pseudopheochromocytoma, orthostatic hypertension, and supine hypertension can also contribute to labile blood pressures in a clinical setting 3
- Emotional factors and the sympathetic nervous system are involved in the cause of paroxysmal hypertension, also known as pseudopheochromocytoma 4
- Blood pressure variability is influenced by complex interactions between intrinsic cardiovascular mechanisms and extrinsic environmental and behavioral factors 5
- Triggers for blood pressure lability include extreme highs and lows in blood pressure measurements, which can occur at irregular intervals 6
Clinical Presentations
- Labile hypertension is characterized by sudden rises in blood pressure, often due to emotional stress, and is linked to unfavorable outcomes 3, 5
- Paroxysmal hypertension presents as dramatic episodes of abrupt and severe blood pressure elevation, and can be disabling 4
- Blood pressure lability can lead to increased cardiovascular risk, including ischemic stroke, heart failure, angina, and myocardial infarction 6