Labile Hypertension

Labile (“lay-bile”) hypertension means your blood pressure goes up and down in a way that can be difficult to predict and may be challenging to manage with medications. It’s not an official diagnosis but rather more of an informal, descriptive term.

Your blood pressure normally fluctuates a bit throughout the day — even within minutes — based on what you’re doing. For example, things like physical activity, salty foods, alcohol, lack of sleep and your body position all can change your blood pressure reading. Your body has to adapt to these changes to support normal blood flow. But with labile hypertension, your blood pressure spikes to levels that wouldn’t be healthy if you had them all the time.

If your blood pressure is otherwise in the normal range, there’s likely no reason to worry. Labile hypertension usually isn’t dangerous and doesn’t require treatment. But it’s a good idea to tell your healthcare provider about any high readings so they’re aware of what’s happening. They may want to keep a closer eye on your blood pressure in case you do need treatment at some point.

Symptoms of labile hypertension

You can have labile hypertension without noticing any symptoms at all. But it’s common to experience symptoms that come on quickly, in response to the stress, and go away once you feel better emotionally. You might notice:

• Flushing or a sense of warmth in your upper body
• Headache
• Heart palpitations (the feeling that your heart is pounding, flip-flopping or fluttering)
• Heavy sweating

Labile hypertension causes

Many things can cause sudden changes in your blood pressure, such as sudden emotional distress. When you’re feeling very stressed or anxious, your sympathetic nervous system jumps into action. This network of nerves sends signals that raise your blood pressure and cause the symptoms mentioned above.

The exact triggers for labile hypertension can vary from person to person. While emotional triggers may be important for some, other triggers may include alcohol, eating salty foods or dramatic response to medications. In many cases, there’s no exact trigger for labile changes in blood pressure.

How doctors diagnose labile hypertension

Your healthcare provider may say you have labile hypertension if they observe a pattern of blood pressures that go up and down unpredictably. Sometimes, this type of blood pressure can be difficult to manage.

Your provider may perform other tests, such as “orthostatic” vital signs. This means they check your blood pressure while you’re in different positions, like lying down, sitting up and standing.

Your provider may also consider looking for neurological causes of labile blood pressure or evidence of stiffening in your aorta and blood vessels. Both of these can sometimes lead to sudden changes in blood pressure.

If the spikes happen when you’re at home, your provider will rely on any information you can share. Using a home blood pressure monitor that saves a history of your readings can be helpful. Or you can keep a log on paper.

Your provider may also ask you to do ambulatory blood pressure monitoring. This type of test measures your blood pressure many times over a 24-hour period. It shows your average readings during the day and night. You’ll also keep a log of what happened that day. This can show if you have high blood pressure all the time or only at certain times.

There isn’t an official threshold for what counts as labile hypertension. But research shows it’s common to have a systolic blood pressure (top number) of 160 mm Hg or higher.

How is labile hypertension treated?

Healthcare providers prescribe medicine to keep your blood pressure at a healthy level. It may take several attempts of prescribing medications in a way to “smooth out” your blood pressure during the course of the day.

This may include taking certain, longer-acting blood pressure medications. Your provider may also suggest taking medications at certain times of the day — for example, at specific times in the morning, at night or with triggers.

Labile hypertension is difficult to treat and will take good documentation and collaboration with your provider.

When should I see my healthcare provider?

Call your provider if you notice your blood pressure readings at home are higher than usual. Your provider may ask you to come in for a checkup. If you think you know the cause, tell your provider. This can help them understand what might be happening.

Call 911 or your local emergency services number if your blood pressure is higher than 180/120 mm Hg (either number) and you have any of the following:

• Chest pain
• Confusion or changes to your thinking
• Dizziness
• Heart palpitations
• Peeing less than usual
• Severe headache
• Seizures
• Signs of a stroke
• Swelling (edema)
• Vision changes

These are signs of a hypertensive emergency. You need medical care right away. It’s rare for labile hypertension to lead to this problem.

What can I expect if I have labile hypertension?

We need more research to know if labile hypertension raises your risk for heart or blood vessel problems. But your provider will likely want to watch and track your blood pressure over time.

If you feel stressed during your blood pressure checks, tell your provider. They may be able to make small changes — like letting you sit in a quiet room for a few minutes — before taking a measurement.

Your provider will also talk with you about things that cause stress and how to manage them. If you’re living with anxiety, treatment options are available.