title: Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies.
abstract: Although "labile hypertension" is regularly encountered by clinicians, there is a paucity of information available to guide therapeutic decisions. This review discusses its clinical relevance, the limitations of current knowledge, and possible directions for future research and clinical management. Results of studies that assessed measures of blood pressure variability or reactivity are reviewed. The limited information about effects of antihypertensive drugs on blood pressure variability is discussed. Two different clinical presentations are differentiated: labile hypertension and paroxysmal hypertension. Labile hypertension remains a clinical impression without defined criteria or treatment guidance. Paroxysmal hypertension, also called pseudopheochromocytoma, presents as dramatic episodes of abrupt and severe blood pressure elevation. The disorder can be disabling. Although it regularly raises suspicion of a pheochromocytoma, such a tumor is found in <2 % of patients. The cause, which involves both emotional factors and the sympathetic nervous system, and treatment approaches, are presented.
authors.affiliation: Division of Nephrology and Hypertension, NY-Presbyterian Hospital-Weill Cornell Medical College, 424 East 70th St, New York, NY, 10021, USA. sjmann@med.cornell.edu.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Mann
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D059466:White Coat Hypertension / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive drugs; Blood pressure variability; Hypertension; Labile hypertension; Paroxysmal hypertension; Sympathetic nervous system