Severe paroxysmal hypertension (pseudopheochromocytoma).
Paroxysmal hypertension always engenders a search for a catecholamine-secreting pheochromocytoma. Yet 98% of people with paroxysmal hypertension do not have this tumor. The cause and management of paroxysmal hypertension remain a mystery, and the subject of remarkably few papers. This review presents an approach to understanding and successfully treating this disorder. Patients experience symptomatic blood pressure surges likely linked to sympathetic nervous system stimulation. A specific personality profile associated with this disorder suggests a psychological basis, attributable to repressed emotion related to prior emotional trauma or a repressive (nonemotional) coping style. Based on this understanding, three forms of intervention, alone or in combination, appear successful: antihypertensive therapy with agents directed at the sympathetically mediated blood pressure elevation (eg, combined alpha- and beta-blockade or central alpha-agonists such as clonidine); psychopharmacologic interventions including anxiolytic and/or antidepressant agents; and psychological intervention, particularly reassurance and increased psychological awareness. An appropriately selected intervention can reduce or eliminate attacks in most patients.
Mann
Samuel J
SJ
New York Presbyterian Hospital-Weill/Cornell Medical School, 450 East 69th Street, New York, NY 10021, USA. sjmann@med.cornell.edu
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory; D003937:Diagnosis, Differential; D004644:Emotions; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D016584:Panic Disorder / Q000150:complications; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis*; D013564:Sympathetic Nervous System / Q000503:physiopathology
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D000959:Antihypertensive Agents