What is labile hypertension (fluctuating blood pressure)?

From the Guidelines

Labile hypertension is a condition characterized by significant and abnormal fluctuations in blood pressure readings within minutes to hours, alternating between normal and elevated levels, and its management should prioritize identifying and managing triggers, lifestyle modifications, and sometimes medications to control fluctuations and reduce the risk of cardiovascular morbidity and mortality. According to the most recent guidelines, such as the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline 1, the definition and management of hypertension have evolved, emphasizing the importance of early detection and treatment to prevent long-term complications. The condition differs from normal daily variations in blood pressure and can be triggered by specific situations like stress, anxiety, physical activity, or certain medications. Common symptoms include headaches, dizziness, flushing, and heart palpitations during blood pressure spikes. Diagnosis typically requires multiple blood pressure measurements taken at different times and settings, often using ambulatory blood pressure monitoring over 24 hours. Some key points to consider in the management of labile hypertension include:

• Identifying and managing triggers
• Lifestyle modifications, such as reducing salt intake, regular exercise, and stress management techniques
• Sometimes, medications like beta-blockers or calcium channel blockers to control fluctuations
• Distinguishing labile hypertension from white coat hypertension or masked hypertension, as the management approaches may differ. It is essential to note that the classification of hypertension and its management should be based on the total cardiovascular risk of each individual, as stated in the 2007 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines 1. In real-life clinical practice, the focus should be on reducing the risk of cardiovascular morbidity and mortality, and the management of labile hypertension should be tailored to the individual patient's needs and risk profile.

From the Research

Definition of Labile Hypertension

• Labile hypertension is defined as a rapid, temporary rise in blood pressure to above 140/90 mm Hg, most often due to emotional stress, followed by a return to normal values 2.
• It is a common problem in daily clinical practice and can lead to increased cardiovascular risk.

Clinical Presentations

• Labile hypertension can present as white coat hypertension, masked hypertension, pseudopheochromocytoma, orthostatic hypertension, or supine hypertension 2.
• Paroxysmal hypertension, also called pseudopheochromocytoma, presents as dramatic episodes of abrupt and severe blood pressure elevation 3.

Diagnosis and Treatment

• Ambulatory blood pressure monitoring is often used for the diagnosis of labile hypertension 2.
• Alpha blockers, beta blockers, and antidepressants are frequently used for treatment 2.
• Beta-blockers can be effective in treating labile hypertension, especially in patients with sympathetically driven hypertension 4.

Management Challenges

• There is a paucity of information available to guide therapeutic decisions for labile hypertension 3, 5.
• The management of labile hypertension is a problem often encountered by clinicians, and there is a need for more research and clinical management guidance 3, 5.