The Clinical Spectrum of Labile Hypertension: A Management Dilemma

  title={The Clinical Spectrum of Labile Hypertension: A Management Dilemma},
  author={Samuel J. Mann},
  journal={The Journal of Clinical Hypertension},
  • S. Mann
  • Published 1 September 2009
  • Medicine
  • The Journal of Clinical Hypertension
Although the management of the labile component of blood pressure elevation is a problem often encountered by clinicians, there is a paucity of information available to guide therapeutic decisions. This review discusses the clinical relevance of blood pressure lability, the limitations of current knowledge, and possible directions for future research and clinical management. 

Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies

  • S. Mann
  • Medicine
    Current Cardiology Reports
  • 2015
Although “labile hypertension” is regularly encountered by clinicians, there is a paucity of information available to guide therapeutic decisions, and it remains a clinical impression without defined criteria or treatment guidance.

Pseudopheochromocytoma: an Uncommon Cause of Severe Hypertension

Treatment of patients with pseudopheochromocytoma should be individualized and management should be focused on treatment of acute hypertensive episodes and prevention of paroxysms.

Neurogenic hypertension: pathophysiology, diagnosis and management

  • S. Mann
  • Medicine, Biology
    Clinical autonomic research : official journal of the Clinical Autonomic Research Society
  • 2018
Although there is much that is unclear in its pathophysiology, recognition of neurogenic hypertension is of considerable clinical importance in individualizing drug therapy and achieving blood pressure control.

Blood Pressure Lability: Triggers, Implications, and Options

The aim of this article is to describe the relationship between blood pressure lability and ischemic stroke, including triggers, implications, and treatment options.

Labile hypertension: a new disease or a variability phenomenon?

The aim of this article was to review and summarize recent evidence on BPV phenomenon, unraveling the labile HTN concept along with the prognostic value of these conditions.

Pressure and Hypertension , Clinical Challenges and Dilemmas beyond Current Guidelines

The call is made to look at hypertension as a syndrome – not just numerical definition and make effort to develop strategies for earlier diagnosis of this syndrome considering blood pressure value as only one of several cardiovascular markers of this Syndrome.


Pseudopheochromocytoma (pseudoPHEO) is manifested as severe, symptomatic paroxysmal hypertension without a significant elevation in catecholamine and metanephrine levels and lack of evidence of tumor

Psychosomatic Research in Hypertension: The Lack of Impact of Decades of Research and New Directions to Consider

  • S. Mann
  • Medicine, Psychology
    Journal of clinical hypertension
  • 2012
It is long past time to either abandon psychosomatic research in hypertension or seek new directions with greater promise of clinical relevance, to explore a different agenda that offers greater promise in understanding and managing hypertension.


Comparison of blood pressure levels across the spectrum of hypertension related signs and symptoms in out patients.

Blood pressure levels were found to be significantly different across categories of a number of clinical manifestations of hypertension, and the observed differences differed among patients with different durations of hypertension.



The clinical significance of white-coat and masked hypertension

The criteria to identify the clinically normotensive patients at elevated pretest probability of MH in whom a broad use of self-measured home BP and 24-hour ambulatory BP as screening tests may be appropriate and cost effective is needed.

Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment.

  • S. Mann
  • Psychology, Medicine
    Archives of internal medicine
  • 1999
A cause and an effective treatment approach are suggested for severe, symptomatic paroxysmal hypertension, which is related to previous severe emotional trauma or to a general tendency to keep distressful emotions out of awareness.

Severe paroxysmal hypertension (Pseudopheochromocytoma)

  • S. Mann
  • Medicine, Psychology
    Current hypertension reports
  • 2008
An approach to understanding and successfully treating paroxysmal hypertension and three forms of intervention, alone or in combination, appear successful: antihypertensive therapy with agents directed at the sympathetically mediated blood pressure elevation, psychopharmacologic interventions including anxiolytic and/or antidepressant agents; and psychological intervention, particularly reassurance and increased psychological awareness.

Recent Advances in Genetics, Diagnosis, Localization, and Treatment of Pheochromocytoma

Advances in genetic mutation analysis have greatly improved identification of patients with familial pheochromocytoma, allowing detection of tumors at an early stage, often before typical signs and symptoms occur and highlighting inadequacies of commonly used diagnostic tests.

Sympathoadrenal function in patients with paroxysmal hypertension: pseudopheochromocytoma

Patients with pseudopheochromocytoma exhibit a pattern of normal sympathetic noradrenergic outflow, adrenomedullary activation, and augmented blood pressure responses to changes in the sympathoneural release of norepinephrine.

Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study.

Within a population of subjects with stage I hypertension, subjects with white coat hypertension have a smaller degree of hypertensive complications than those with sustained hypertension, irrespective of their blood pressure levels taken in the office, and cardiac involvement seems to precede glomerular damage in the early stage of hypertension.

Pressor Responses to Noxious Stimuli in Hypertensive Patients: Effects of Reserpine and Chlorothiazide

The pressor and pulse rate responses to three standardized noxious stimuli were determined in groups of hypertensive patients receiving reserpine and chlorothiazide, alone and in combination.

Prediction of coronary and cerebrovascular morbidity and mortality by direct continuous ambulatory blood pressure monitoring in essential hypertension.

Ambulatory blood pressure is superior to clinic measurement for the assessment of cardiovascular risk; there is no reduction in coronary risk at lower levels of ambulatory diastolic blood pressure.