Labile hypertension is roughly defined as a transient but significant increase in blood pressure, primarily as a result of anxiety and emotional distress, with sympathetic stimulation of adrenergic receptors being the most probable cause. Headaches, flushing, and palpitations may appear as blood pressure increases. At this moment, diagnostic and therapeutic guidelines do not exist and an individualized approach is necessary.
Presentation
Sudden elevation in the blood pressure may be asymptomatic, but individuals can report headaches, palpitations, and flushing that are provoked by an emotional distress [1]. These findings are important distinguishing criteria from paroxysmal hypertension, in which symptoms cannot be linked to a specific trigger [1].
Entire Body System
- Pain
This may or may not be painful. If painful symptoms start, have your child see one of our doctors as soon as possible. [columbiadoctors.org]
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: March 7, 2020 [patientslikeme.com]
Pain and injury are frequent components of EDS, and there is evidence suggesting movement disorders cause these injuries. [ehlers-danlos.com]
Hypertensive crisis is typically accompanied by symptoms like: Chest pain Shortness of breath Back pain Numbness Weakness Changes in vision Difficulty speaking Risks of Labile Hypertension Unusual, and sometimes unexplained, spikes in your blood pressure [webmd.com]
English 56 cheilitis, difficulty swallowing (dysphagia), mouth ulceration, gall stones cholelithiasis, rash, hair loss, cystitis, renal cyst, urinary retention, pelvic pain, injection site pain, weight loss, and hypothermia. [mymemory.translated.net]
- Weakness
Here we briefly report on problems that arise from symptoms like weakness of the ligaments of the neck, back problems, and the weakness of the protective layers around nerves. [ehlers-danlos.com]
General weakness or lethargy. [kauveryhospital.com]
However when the average blood pressure in the midst of these fluctuations is high enough individuals may experience the usual symptoms of high blood pressure such as headache, dizziness, weakness and others. [mtatva.com]
Hypertensive crisis is typically accompanied by symptoms like: Chest pain Shortness of breath Back pain Numbness Weakness Changes in vision Difficulty speaking Risks of Labile Hypertension Unusual, and sometimes unexplained, spikes in your blood pressure [webmd.com]
These symptoms may include: Headache Dizziness Weakness As with chronic cases of high blood pressure, years of poor management may lead to stroke, heart disease, and heart failure. [belmarrahealth.com]
- Weight Loss
Treatment Stress management, reduction of salt and fat intake in your diet, weight loss motivation and an increase in regular exercise are all likely to be recommended if you have labile hypertension. [treating-hypertension.com]
Alzheimer’s Disease Arthritis Autism Back Pain COPD Depression Diabetes Complications Food Allergies Heart Disease Psoriasis Weight Loss Recipes More. Reader Interactions [projectintegrate.eu]
English 56 cheilitis, difficulty swallowing (dysphagia), mouth ulceration, gall stones cholelithiasis, rash, hair loss, cystitis, renal cyst, urinary retention, pelvic pain, injection site pain, weight loss, and hypothermia. [mymemory.translated.net]
Measures like: Exercise Diet Smoking cessation Alcohol restriction (1 or 2 drinks a day) Weight loss (easier said than done) Sodium (salt) reduction Deep breathing exercises Herbs and other supplements. [bloodpressure-drs-practical-guide.com]
- Asymptomatic
Sudden elevation in the blood pressure may be asymptomatic, but individuals can report headaches, palpitations, and flushing that are provoked by an emotional distress. [symptoma.com]
This particularly refers to asymptomatic labile high blood pressure where patients are not even aware of the presence of the disease. [ic.steadyhealth.com]
At times, labile hypertension may even be asymptomatic, i.e., it may not give rise to any visible or palpable symptoms. [buzzle.com]
Página 67 - Asymptomatic gonorrhea in men: Diagnosis, natural course, prevalence and significance. N Engl J Med 290:117, 1974. Página 68 - Gunn. SW, Prevalence of cervical intraepithelial neoplasia in sexually active teenagers and young adults. [books.google.es]
- Fatigue
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: March 7, 2020 [patientslikeme.com]
The first large study examines spinal issues in chronic fatigue syndrome (ME/CFS). A couple of years ago, there was hardly any discussion of spinal issues in ME/CFS. [healthrising.org]
Felt worse last summer: heart pounding, dizzy spells, shaky, nervous, insomnia, headaches, fatigue. I was put on 25mg Toporol XL, it didn't help much. [doctorslounge.com]
Respiratoric
- Dyspnea
Imaging Studies: Chest x-ray Perform chest x-rays (CXRs) to evaluate for pulmonary edema in the setting of dyspnea or hypoxia occurring in a woman with preeclampsia. [csh.org.tw]
Table II).18, 19 Paroxysms characteristically begin very abruptly and can last minutes, hours, or even days.19 Abrupt BP elevation is accompanied by prominent and very distressing physical symptoms, such as headache, palpitations, flushing, weakness, or dyspnea [onlinelibrary.wiley.com]
II). 18, 19 Paroxysms characteristically begin very abruptly and can last minutes, hours, or even days. 19 Abrupt BP elevation is accompanied by prominent and very distressing physical symptoms, such as headache, palpitations, flushing, weakness, or dyspnea [ncbi.nlm.nih.gov]
- Sneezing
Smoking a pipe was again relegated to portraits of lowly commoners and country folk and the refined sniffing of shredded tobacco followed by sneezing was rare in art. [en.wikipedia.org]
Liver, Gall & Pancreas
- Jaundice
Examination revealed a young girl, small for age (weight 11.5kg), irritable, not pale, acynosed, and not jaundice. [bioline.org.br]
Cardiovascular
- Hypertension
So far, advanced age is defined as a significant risk factor for labile hypertension and the term labile hypertension in elderly (LHE) was proposed as a distinct clinical entity. [symptoma.com]
An increase in heart rate and a reduction in carotid pulse upstroke time (Ut) in labile hypertensives differentiated this group from chronic hypertensives and normal subjects. [ncbi.nlm.nih.gov]
[…] of sustained hypertension. [onlinelibrary.wiley.com]
Wildly fluctuating blood pressure readings are characteristic of labile hypertension According to the Canadian Hypertension Society Consensus guidelines, labile hypertension, also known as borderline hypertension, is a variation of hypertension where [drtytus.com]
- Heart Disease
(CAD) such as angina and myocardial infarction (commonly known as a heart attack).[2] Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular [en.wikipedia.org]
Alzheimer’s Disease Arthritis Autism Back Pain COPD Depression Diabetes Complications Food Allergies Heart Disease Psoriasis Weight Loss Recipes More. Reader Interactions [projectintegrate.eu]
More recent research has revealed that untreated labile hypertension puts you at a higher risk of heart disease and death due to all causes, compared to those who are treated. [healthline.com]
- Palpitations
Sudden elevation in the blood pressure may be asymptomatic, but individuals can report headaches, palpitations, and flushing that are provoked by an emotional distress. [symptoma.com]
In these cases, beta-blockers are not used to lower blood pressure, but rather to reduce the symptoms associated with these conditions such as flushing, palpitations, or headaches. They’re often used in combination with anti-anxiety treatments. [healthline.com]
- Tachycardia
[…] lt Traukiny nukritau nuo lentynos, makaule trenkiausi en Signs and symptoms Very common symptoms in overdose (> # % incidence) include tachycardia, agitation/aggressiveness, dysarthria, various extrapyramidal symptoms, and reduced level of consciousness [lt.glosbe.com]
Labile hypertension and episodic tachycardia are not usually observed. [journals.plos.org]
Again, hemodynamic instability was pronounced, with a hypertensive crisis and tachycardia at the beginning and the end of the procedure (figure 1). The hypertensive crisis was treated with intravenous propranolol and urapidil. [signavitae.com]
- Thrombosis
Magnetic resonance venography also may be performed to exclude cerebral venous sinus thrombosis. [csh.org.tw]
Venous thrombosis Cerebral venous sinus thrombosis leads to stroke due to locally increased venous pressure, which exceeds the pressure generated by the arteries. [en.wikipedia.org]
Germany DIC Disseminated Intravascular Coagulation In English → Pathology DKUHD Division of Kidney, Urologic, and Hematologic Diseases In English → Physiology → Pathology DRAA Dialysis-Related Amyloid Arthropathy In English → Pathology DVT Deep Vein Thrombosis [en.hades-presse.com]
Five new oral anticoagulants (NOAC) are currently used in clinical practice (for prevention of stroke in patients with AF or for the prevention of deep vein thrombosis). [hrcak.srce.hr]
Skin
- Flushing
Sudden elevation in the blood pressure may be asymptomatic, but individuals can report headaches, palpitations, and flushing that are provoked by an emotional distress. [symptoma.com]
In these cases, beta-blockers are not used to lower blood pressure, but rather to reduce the symptoms associated with these conditions such as flushing, palpitations, or headaches. They’re often used in combination with anti-anxiety treatments. [healthline.com]
Urogenital
- Kidney Failure
heart attack and kidney failure. [biljni-preparati.com]
High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. [icdlist.com]
Keeping blood pressure well controlled will result in a marked reduction in the risk of strokes, heart failure, kidney failure, and heart attacks. Authored by: Richard B. Johnson, PhD., M.D., F.A.C.P. Back to Disease Menu [diagnosticclinic.com]
Medications didnt seem to work for him, although he continues to take meds, and now, he has complete kidney failure and is on dialysis. My story, I've always had high blood pressure, even as a kid. [healthboards.com]
Neurologic
- Stroke
In the UK-TIA study, a total of 104 patients had a subsequent stroke. [tandfonline.com]
Association of systolic blood pressure variability with mortality, coronary heart disease, stroke, and renal disease. [verywellhealth.com]
Visit-to-visit BPV BPV between visits has been correlated with CAD, stroke, and all-cause mortality [22, 33, 34]. [nature.com]
Radiocardiography with 131IRHISA was employed in order to calculate: Cardiac output and index (CO, CI); stroke volume and index (SV, SI), total blood volume and index (TBV, TBVI) and total peripheral resistance (TPR). [ncbi.nlm.nih.gov]
- Headache
Sudden elevation in the blood pressure may be asymptomatic, but individuals can report headaches, palpitations, and flushing that are provoked by an emotional distress. [symptoma.com]
[…] rural family practice over a three-year period and compared to randomly selected age- and sex-matched controls for the following concurrent diagnoses: generalized anxiety, psychogenic spastic bladder, panic disorder, depression, alcohol use, chronic headache [ncbi.nlm.nih.gov]
Headache in Ehlers-Danlos Syndrome EDS patients commonly suffer a variety of headache types. [ehlers-danlos.com]
This fluctuation may cause ringing in the ears or headaches, and could stem from emotional stress throughout the day. The Canadian Task Force on Preventative Health Care found that almost 15 percent of the adult population has labile hypertension. [drtytus.com]
The fluctuation of pressure can consequently lead to ringing in the ears and headache. Causes of Labile High Blood Pressure There are several factors which contribute to occurrence of labile high blood pressure. One of the leading causes is stress. [ic.steadyhealth.com]
- Agitation
[…] medicinal products) included somnolence, coma, serotonin syndrome, seizures,, vomiting and tachycardia lt Traukiny nukritau nuo lentynos, makaule trenkiausi en Signs and symptoms Very common symptoms in overdose (> # % incidence) include tachycardia, agitation [lt.glosbe.com]
When purposeful movements are observed with agitation, such as pulling out tubes or hitting, as seen at Rancho Los Amigos levels III and IV, PAID is clearly not the cause of agitation. [jamanetwork.com]
Prevention of dysautonomic crises, agitation, and rigidity were managed with benzodiazepines, benztropine, and diphenhydramine. [clinmedjournals.org]
In addition, readings taken specifically at times of suspected BP elevation, eg, during perceived agitation, can be misconstrued as excessive lability rather than appropriate physiologic reactivity. [onlinelibrary.wiley.com]
Additionally, look for evidence of drug intoxication or withdrawal (agitation, pupillary changes, tremor). On eye exam, funduscopic exam can point to longstanding hypertension, which can be useful when considering an acute presentation. [clinicaladvisor.com]
- Tremor
[…] en Acute (single-dose) toxicity Signs of oral toxicity in rodents were characteristic of potent neuroleptic compounds: hypoactivity, coma, tremors, clonic convulsions, salivation, and depressed weight gain en Signs and symptoms of overdose (duloxetine [lt.glosbe.com]
Antidiabetic medicines Labil 20 MG Injection may mask the symptoms of low blood glucose levels like tremors, fast heartbeat, palpitations and makes it difficult for the patients to understand. [lybrate.com]
Look for evidence of drug withdrawal (such as tachycardia, tremor, and tongue fasciculations in alcohol withdrawal). Consider nephrogenic causes. In cases of severe hypertension, all patients will require a metabolic panel. [clinicaladvisor.com]
The symptoms of APC include severe abdominal pain, vomiting, constipation, acute psychiatric and neurologic manifestations, tachycardia, hypertension, tremors, excessive sweating, urinary retention, cardiac arrhythmias, electrolyte disturbances and acute [signavitae.com]
Disorders of too much movement such as uncontrolled muscle contraction, tremor, fidgeting/dancing movements, twitches, and jerking are reported from EDS patients. [ehlers-danlos.com]
- Dysautonomia
Case Reports Friedreich's ataxia with dysautonomia and labile hypertension D Margalith et al. Can J Neurol Sci. 1984 Feb. [pubmed.ncbi.nlm.nih.gov]
DESIGN/METHODS: Afferent baroreflex failure occurs in patients with the genetic disorder familial dysautonomia (FD, Riley-Day syndrome or hereditary sensory and autonomic neuropathy type 3) and in patients with acquired lesions of the afferent baroreflex [n.neurology.org]
Peixoto, MD, professor of medicine and clinical chief of the section of nephrology and co-director of the hypertension and dysautonomia program at the Yale School of Medicine and Yale New Haven Hospital Heart and Vascular Center, said during his presentation [healio.com]
Four cases of posttraumatic dysautonomia successfully treated with intrathecal baclofen, a muscle relaxant, illustrate this point.11 Most often, more than 1 drug is required for control. [jamanetwork.com]
Workup
Defined diagnostic criteria do not exist at this moment [5], but continuous monitoring of patients and their blood pressure is useful in assessing the onset and possible triggers of blood pressure elevations.
Treatment
Therapeutic guidelines are yet to be defined [1] [5]. For patients who do experience repeated bouts of increased BP prior to basic medical or surgical procedures, anxiolytic agents (lorazepam, alprazolam) and alpha or beta blockers (doxazosin, labetalol, clonidine) may be recommended as a short-term solution [1].
Prognosis
The effects of labile hypertension on the cardiovascular system are unclear [1], but studies have proposed that marked impairment in the quality of life may be present in the elderly [3]. More importantly, labile hypertension may be a significant challenge in patients who suffer from anxiety when visiting a doctor or prior to medical or surgical procedures, which necessitates prophylactic antihypertensive drug use [1].
Etiology
Anxiety and emotional distress are by far the most common cause of labile hypertension [1], but numerous conditions have been mentioned as potential causes [2]:
- Hyperthyroidism
- Renovascular hypertension
- Migraine headache
- Alcohol withdrawal
- Baroreflex failure
- Drug-induced (clozapine, amphetamines, cocaine)
- Carcinoid syndrome
- Seizures
Epidemiology
The exact incidence rates of labile hypertension in the population are unknown, but it is estimated that more than 40 million adults have uncontrolled blood pressure in the United states and roughly 1% of those individuals will suffer a hypertensive crisis during their lifetime [6]. So far, advanced age is defined as a significant risk factor for labile hypertension and the term labile hypertension in elderly (LHE) was proposed as a distinct clinical entity [3] [4].
Pathophysiology
Stimulation of adrenergic receptors by emotional stress and anxiety is thought to be the main pathophysiologic event [1]. Fluctuations in blood pressure occur during various physiological and pathological states, however, most common examples being physical activity, sleep deprivation, alcohol intake and numerous cardiovascular and endocrine diseases [1]. For this reason, a clear definition of the term remains to be solidified.
Prevention
Various strategies exist for preventing essential hypertension (avoidance of cigarette smoking and consumption of high amounts of alcohol, regular exercise, healthy dietary habits, etc), but how labile hypertension can be prevented is still unclear, having in mind the fact that both physiological and pathological events can induce this condition [1].
Summary
Labile hypertension is a term that describes sudden, transient blood pressure (BP) elevations, most likely in the setting of emotional distress and anxiety [1], but a myriad of diseases (hyperthyroidism, seizures, migraine attacks, alcohol withdrawal, etc.) may induce this clinical phenomenon as well [2]. Labile hypertension was initially described as a category between normotension and hypertension [1], but BP elevations may be induced by various factors, such as physical activity, intake of salt and alcohol, sleep deprivation and many other, which is why a clear definition of this term is yet to be made [1]. Age is considered to be the most significant risk factor and the term labile hypertension in elderly (LHE) was coined to emphasize its role in the quality of life and overall prognosis in this age group [3] [4]. The pathogenesis is thought to involve stimulation of adrenergic alpha and beta receptors by the sympathetic nervous system in stressful situations and this response may be followed by headaches, palpitations, and flushing, but it is not uncommon for labile hypertension to be asymptomatic [1]. Marked BP elevations frequently occur before medical procedures and physician visits, but the diagnosis may be difficult to attain, as there are no clear diagnostic criteria for the condition, nor do treatment guidelines exist at this moment [1] [5]. Repetitive and frequent BP measurement under carefully planned circumstances may be of use, however, but both diagnosis and management rely on the attending physician [1].
Patient Information
Labile hypertension is a term used to describe transient but a sudden increase in blood pressure, most frequently triggered by emotional stress and anxiety. A range of conditions is thought to induce blood pressure elevations as well, including hyperthyroidism, seizures, migraine headaches and several other, but also physiological conditions such as physical activity. For this reason, clear diagnostic criteria are yet to be defined and so far, the only known risk factor is advanced age. In fact, the term labile hypertension in elderly (LNE) is considered as a separate clinical entity. The clinical presentation may be asymptomatic, but headaches, palpitations, and flushing may be reported by patients immediately after some form of psychological distress. The diagnosis can be suspected through long-term blood pressure monitoring, but it may be difficult to obtain an objective result, as hypertension can occur when visiting a hospital (white coat hypertension) or even during measurement at home. For this reason, therapeutic guidelines do not exist and therapy is only indicated when patients are unable to go through a medical or surgical procedure. At this moments, anxiolytics and alpha or beta blockers are used in these patients. It is still unknown whether this form of hypertension is a risk factor for other cardiovascular diseases and the quality of life in general, but this clinical entity is known to be harmful in the elderly, which is why early recognition may be helpful.
References
- Mann SJ. The clinical spectrum of labile hypertension: a management dilemma. J Clin Hypertens (Greenwich). 2009;11(9):491-497.
- Ma RCW, Yiu KH, Wong EHC, et al. A Man with Labile Blood Pressure. PLoS Med. 2007;4(4):e111.
- Nedostup AV, Fedorova VI, Dmitriev KV. Labile hypertension in elderly: clinical features, autonomic regulation of circulation, approaches to treatment. Klin Med (Mosk). 2000;78(7):27-32.
- Elliott MR, Soto Soto JM, Haley WE, Fitzpatrick PM, Dwyer JP. Labile hypertension: characteristics of a referred cohort. Clin Exp Hypertens. 2013;35(3):207-212.
- Mann SJ. Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies. Curr Cardiol Rep. 2015;17(11):99.
- Varon J. Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises. Am J Emerg Med. 2007;25(8):949-959.