Blood pressure (BP) is a dynamic process. It is constantly adapting to environmental, emotional, and physical changes. As such, you can expect your BP to rise and fall as you go about your day. With labile hypertension, your blood pressure may suddenly, repeatedly and drastically increase.
Getting into an argument, receiving an unexpected bill, or even talking to your landlord can cause surges in your BP. These surges usually remain within healthy ranges. But in certain cases, BP can rise suddenly and unpredictably to unhealthy levels on a regular basis.
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What Is Labile Hypertension?
Labile hypertension is the recurrent, sudden, and often unexplainable surges of BP to dangerously high levels. According to the Canadian Task Force on Preventative Health, about 15% of Canadian adults might have labile hypertension.
Increasing with age, labile hypertension is more common among men over age 60 and menopausal women. Although doctors have been aware of labile hypertension for a while, its mechanism is still poorly understood. There are no criteria to define the condition, and neither are there universal guidelines for its treatment.
Understanding Blood Pressure
Normal blood flow is essential to life. Your blood travels through a vast, interconnected network of blood vessels called arteries and capillaries. Through these blood vessels, your blood delivers oxygen and nutrients to vital organs like your kidneys, brain, and lungs.
Every beat of your heart pushes blood through your arteries. The force which your blood uses to move through your arteries is your BP. Depending on your needs, your heart adjusts the speed of its pumping and the amount of blood it pumps out.
Your arteries, too, make constant adjustments. They can become narrower (vasoconstriction) or wider (vasodilation) as needed. This ability to widen or constrict is essential in maintaining optimal blood pressure and a healthy blood flow to your tissues.
For example, when you’re cold, your arteries constrict to reduce heat loss and divert blood flow to your core. This helps keep you warm in the winter. When there’s an infection, your body responds by increasing blood flow. This delivers nutrients and immune cells where they’re needed most.
BP is regulated by a complex interaction between hormones and nerve impulses. In healthy people, a normal BP is:
- Systolic (top number) of 100 to 120 mmHg. The systolic reading measures your BP when your heart is beating.
- Diastolic (lower number) of 60 to 80 mmHg. This number represents the BP between heartbeats when your heart is resting.
Hypertension occurs when your innate BP regulatory mechanisms fail, and blood has to flow more forcefully than normal. Health Canada defines hypertension as a sustained systolic pressure of over 120 mmHg and a diastolic pressure of above 80 mmHg.
Hypertension is considered ‘primary’ when caused by bad genes, excess weight, and an unhealthy lifestyle. It can also be ‘secondary’ when related to an underlying medical condition.
Unique Characteristics and Symptoms of Labile Hypertension
Unlike primary and secondary hypertension, labile hypertension is transient. You can have one or more episodes per day. Episodes last from minutes to hours and usually resolve without treatment.
Labile hypertension occurs almost exclusively in response to anxiety-inducing events. This can be any stressful situation like getting a parking ticket, an argument with your spouse, or an altercation with a neighbor.
Going to the doctor can also cause BP surges in some people. In fact, studies have shown that people who have labile hypertension tend to be more anxious at the doctor’s clinic. This phenomenon is called “white coat” hypertension.
Labile hypertension can be asymptomatic or be accompanied by symptoms like:
- Profuse sweating
- Feeling of faintness
- Pounding headache
- Blurred vision
What Causes Labile Hypertension?
The mechanisms behind labile hypertension are still poorly understood, but it is most often associated with:
Stress and anxiety. When you encounter a stressor, your fight-or-flight response takes over your body. This response is controlled by your sympathetic nervous system (SNS). Activation of your SNS produces physiologic changes that help you overcome stressors.
For example, your SNS releases hormones like epinephrine. Epinephrine gives you a boost of energy. It increases heart rate, improves lung capacity, and improves mental clarity. However, epinephrine also causes your arteries to constrict, causing your BP to surge.
Physiologic and mental reactivity to stress. Stress is a fact of life. However, the experience of stress is highly individual. Some people are built to be more mentally resilient. Somehow, others are more sensitive to the physiologic effects of stress.
In a 2021 study, people who reacted with anger and frustration to stress also experienced higher BP fluctuations. Meanwhile, those who responded to stress with calmness had more stable BP. Physiologic sensitivity to stress can sometimes be caused by baroreflex failure.
Baroreflex failure. The baroreceptor reflex is one of the body’s innate BP regulatory mechanisms. Baroreceptors are sensors located along arteries in your chest and neck.
These sensors detect BP changes and relay this information to the brain. The brain then sends instructions to increase or reduce BP. If baroreceptors fail to sense BP changes, it can cause severe labile hypertension.
Drug side effects. Stimulants, ibuprofen, oral steroids, and hormonal contraceptives may also trigger labile hypertension.
Other possible causes:
- High-salt diet
- Illicit drug use
How Is Labile Hypertension Diagnosed?
If your physician suspects labile hypertension based on your symptoms, you will need to undergo 24-hour ambulatory BP monitoring. This allows your physician to:
- Observe patterns
- Differentiate normal daily fluctuations from abnormal fluctuations
- See how high and often your BP spikes
- Rule out “white coat” hypertension
Ambulatory BP monitoring is also the only way to spot “masked” hypertension. People with masked hypertension have high BP, but they tend not to show it in medical settings.
With ambulatory monitoring, you’re going to be attached to and sent home with a portable BP monitor. The monitor automatically measures your BP every 20 minutes as you go about your day. It also measures your BP every 30 minutes at night.
There is usually no minimum BP reading or amount of spikes that is needed to diagnose labile hypertension. Should abnormal BP spikes be detected, the next step is to determine your triggers.
Effects of Labile Hypertension on the Body
Short-term surges in BP are usually harmless. However, unmanaged chronic labile hypertension can cause similar effects on the body as primary or secondary hypertension. The damage starts in the walls of the blood vessels, and if left untreated, it can:
- Increase heart attack and stroke risks
- Lead to chronic kidney disease
- Cause irregular heartbeats and heart failure
- Cause vision loss
- Increase dementia risk
In certain people, even slight rises in BP can be dangerous. For example, those with chronic aortic dissection, Marfan syndrome, angina, or a history of hemorrhagic stroke are more vulnerable to sudden BP changes. If you have any of these medical conditions, tight BP control is necessary.
Paroxysmal hypertension and labile hypertension are often used interchangeably. They both share many of the same symptoms, including flushing, sweating, and palpitations. But they are two separate medical conditions with key differences.
- Symptom characteristics: Paroxysmal hypertension is always accompanied by symptoms, while labile hypertension can sometimes be asymptomatic.
- Precipitating factor: Paroxysmal hypertension is not triggered by emotional distress. Patients often describe its onset as “out of the blue.” Some people do experience anxiety or feelings of imminent death during attacks.
- Underlying medical condition: Some cases of paroxysmal hypertension is caused by a tumor of the adrenal gland called pheochromocytoma. These tumors produce high levels of epinephrine, causing severe hypertension.
Autonomic dysfunction or dysautonomia is a disorder of the autonomic nervous system (ANS). The ANS is the part of the nervous system that controls involuntary functions like breathing and blood pressure. When it fails, it can cause severe BP fluctuations.
But unlike labile hypertension, dysautonomia swings BP both upward and downward. Moreover, people with dysautonomia experience any combination of:
- Abnormally slow or fast heart rate
- Abnormally low or high body temperature
- Excessive sweating or cold hands and feet
- Exercise intolerance
Dysautonomia occurs as a complication of Parkinson’s disease and viral infections. More recently, dysautonomia has been found to affect 2.5% of COVID survivors.
How Is Labile Hypertension Managed?
The first step in getting your BP under control is to get diagnosed. Your doctor may do additional testing to figure out what’s causing your BP fluctuations. With proper management, most people live a normal symptom-free life and prevent long-term complications.
1. Eliminate or avoid triggers
To prevent future episodes, it would be necessary to control your triggers. For example, if you’re a coffee lover, you may need to cut down on your consumption or avoid it altogether. If you happen to be taking medications that can affect BP, you may need to work with your doctor to find safer alternatives.
2. Prescription medications
Medical management is aimed at controlling BP and managing anxiety. The most common drugs used in managing labile hypertension include:
- Alpha (e.g. clonidine) and beta-blockers (e.g. carvedilol, atenolol) block hormones that cause high BP. Clonidine is particularly effective in managing symptoms of baroreceptor failure.
- Selective Serotonin Reuptake Inhibitors (e.g. paroxetine, fluoxetine) may be prescribed for the long-term management of anxiety.
- Anti-Anxiety drugs (e.g. lorazepam, alprazolam) may be needed before medical procedures.
3. Adopt a healthy lifestyle
A healthy lifestyle not only helps manage your BP, but it’s also the one thing you can do on your own that pays long-term dividends.
- DASH diet. The Dietary Approach to Stop Hypertension, or the DASH diet, emphasizes whole grains, fruits, and plant-based proteins. It’s been shown to be effective at managing hypertension.
- Up your magnesium intake. Magnesium is a mineral that helps relax muscles. Studies have shown that magnesium could help reduce BP and manage symptoms of anxiety. Get your daily dose of magnesium from nuts, seeds, legumes, and dark leafy vegetables.
- Mind your potassium. By clearing out sodium and promoting blood vessel relaxation, potassium has been shown to manage BP and keep your heart beating in a normal rhythm. Food sources rich in potassium include the mighty banana, orange, and cantaloupe.
- Stress reduction. Eliminating stress from your life is impossible, but you can change the way your mind and body respond to it. Meditation, yoga, and controlled breathing can help you build a more stress-resilient mind and body.
4. Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is the gold-standard approach to managing anxiety and stress-related disorders. With the guidance of a mental health professional, CBT helps you identify negative thought patterns that cause you to respond disproportionately to daily stressors. In many cases, CBT has been found to deliver long-term changes in mindset and reduction in symptoms of anxiety disorders.
How SRx Can Help You Manage Labile Hypertension
Getting healthcare has never been simpler. With SRx Health’s virtual care solutions, you can tap into our extensive network of specialists and attend anxiety-free doctor appointments from the comfort of your own home.
At SRx, we practice an innovative, sustainable care model where you take an active role in determining your outcomes. Whether you’re looking for a cardiologist who can guide you through a diagnosis and your treatment options or a therapist you can talk to about your anxiety, hassle-free comprehensive care is right at your fingertips.
Reach out to learn more about our pharmacy and medication delivery services!