Sporadic High Blood Pressure

Hypertension, also known as High Blood Pressure (HBP) is defined, according to The American Heart Association, as a persistently high increase in the force or pressure of blood as it flows through blood vessels.¹

Hypertension is regarded as a silent killer because most times, there are no apparent symptoms of the disease until  a late stage, when it would have caused significant damage to major organs such as the heart, brain, kidneys, eyes et cetera.¹

High blood pressure is measured using two numbers as culled from an article by the Centre for Disease Control and Prevention(CDC).²

The first number is the Systolic Blood Pressure (SBP). Systolic blood pressure refers to the blood pressure or force in the arteries when the heart muscles contract to pump out blood,  when the heart beats, resulting in blood being pushed out.²

The second number is the Diastolic Blood Pressure (DBP). Diastolic blood pressure is the blood pressure or force in the arteries when the heart muscles relax to fill with blood, which  is when your heart rests between beats.² Both systolic  and diastolic   blood pressure are measured in millimetres of mercury (mmHg). 

The American Heart Association sets the following systolic and diastolic values for diagnosing and staging hypertension:¹

• Normal blood pressure - systolic value less than 120mmHg and diastolic value less than 80mmHg
• Elevated blood pressure - systolic value between 120-129 mmHg and diastolic value less than 80 mmHg
• Stage 1 Hypertension - systolic value between 130-139 mmHg or diastolic value between 80-89 mmHg
• Stage 2 hypertension - systolic value greater than 140 mmHg or diastolic value greater than 90 mmHg
• Hypertensive crisis - systolic value greater than 180 mmHg and/or diastolic value greater than 120 mmHg¹. A hypertensive  crisis demands immediate consultation with your doctor

Hypertension poses a major risk factor for developing major chronic illnesses such as stroke (cerebrovascular accident), myocardial infarction and chronic kidney disease.³ Approximately 86 million adults in the United States of America are affected by high blood pressure, and it has been identified as the most common primary diagnosis in the United States of America.⁴

Primary hypertension and secondary hypertension are the major categorisations  of hypertension. Primary or essential hypertension is diagnosed when the cause of hypertension can not be attributed to an identifiable secondary cause.⁵ It means the cause of hypertension is unknown. In secondary hypertension, the cause can be identified such as endocrine disorders, and primary hyperaldosteronism.⁵ There is also another growing category of hypertension known as labile  or sporadic  hypertension. Labile hypertension is a sudden, transient, but substantial increase in blood pressure.^{6, 7} This type of hypertension is usually caused by anxiety or other forms of emotional stress.⁶

Patients with hypertension can live a normal, healthy life with proper lifestyle modification, compliance to medications, regular blood pressure checks , and staying up to date with r medical appointments.

Understanding high blood pressure

What causes high blood pressure? 

Blood pressure is determined by the cardiac output (the amount of blood the heart pumps) and peripheral resistance (how easy or hard blood flow through the arteries is).⁸ This means that the narrower the arteries are, the higher the blood pressure. It also means that the more blood the heart pumps, the higher the blood pressure. 

As stated earlier, hypertension can be categorised into primary/essential hypertension where no cause is identified and secondary hypertension where there are identifiable causes. Labile hypertension caused by anxiety or emotional distress is also a growing category. 

Secondary hypertension is caused by a health condition the individual has. It appears more suddenly and causes higher blood pressure readings compared to primary hypertension.⁸

The health conditions and medicines listed below can cause secondary hypertension:

• Thyroid (a butterfly-shaped organ located in front of the neck that produces hormones controlling metabolism) problems
• Adrenal gland (an organ that sits on top of the kidneys on both sides that produce hormones controlling key body functions such as blood pressure, metabolism, stress)
• Congenital heart defect, heart vessels problem present at birth 
• Kidney disease e.g renal artery stenosis
• Diabetes
• Primary aldosteronism (problem with the hormone aldosterone which controls salt and water) 
• Obstructive sleep apnea 
• Drugs such as cocaine, amphetamine⁸

Risk factors

Certain factors make people more prone to developing hypertension, and this includes:

• Age greater than 65
• Ethnicity , black people are at more risk of developing hypertension 
• Eating too much salt 
• Family history, having parents or siblings with hypertension puts a person at risk of developing hypertension 
• Obesity or overweight (increases risk of high cholesterol, high blood sugar) 
• Consuming too much alcohol
• Lack of exercise 
• Tobacco use 
• Stress 

Symptoms

High blood pressure is a silent killer because symptoms do not manifest until  much later, even when the blood pressure readings are very high. 

Some people might have

• Headaches 
• Palpitations 
• Chest pain
• Blurry vision 
• Shortness of breath 
• Nosebleeds⁸

Sporadic high blood pressure

Blood pressure (BP) fluctuation from moment to moment is a normal occurrence, and can be caused by position, stress, emotions, diet, physical activity among others.⁶

Blood pressure fluctuation can be well described using terms such as blood pressure variability, blood pressure reactivity, and blood pressure liability.⁶

BP variability is the mean variation of BP throughout the day. BP reactivity is environmental stress response.⁶

Sporadic or labile hypertension is a sudden, transient, but substantial increase in blood pressure.^6,7

The blood pressure elevation is due to emotional stress. Labile or sporadic hypertension can occur during blood pressure measurement at home or at the physician's office. 

When sporadic hypertension occurs only at the physician's office, it is termed White Coat Hypertension.⁶

Symptoms of labile hypertension include: flushing, headache, and palpitation. In some cases, there might be no symptoms.

Common causes

• Anxiety 
• Emotional stress 
• Emotional distress

Treatment and prevention 

In the management of hypertension, a combination of medication use and lifestyle modification is necessary. 

Obesity/overweight, eating too much salt, consuming too much, and lack of exercise among other risk factors are lifestyle behaviour that can be modified in the treatment of hypertension. 

eart healthy lifestyle modifications may be necessary in the management of hypertension include:

• Eating a diet with less salt 
• Weight reduction of obese or overweight 
• Reducing alcohol consumption 
• Regular physical activity 
• Stopping smoking 
• Managing stress 
• Getting good sleep,  between at least 7 - 9 hours per night⁸ 

Lifestyle modification alone might sometimes not be enough, and medication becomes a necessary addition. 

Medications are used to treat work in different ways. Some help the body get rid of excess salt and water, some help relax the muscles of blood vessels, and some make the heart beat with less force resulting in a reduced heart rate.²

Examples of common blood pressure medications are:

• Angiotensin Converting Enzyme (ACE) inhibitors – such as lisinopril, perindopril, and ramipril
• Angiotensin-2 receptor blockers (ARBs) – such as candesartan, irbesartan, losartan, valsartan 
• Calcium channel blockers – such as amlodipine, felodipine, and nifedipine or diltiazem 
• Diuretics (water pills) – such as indapamide and bendroflumethiazide
• Beta blockers – such as propranolol, atenolol, and bisoprolol
• Alpha blockers – such as doxazosin⁹

Clinical trials are always ongoing to learn and  know more about hypertension and how to manage it better. Researches help to improve existing medications or treatment modalities or come up with new ones.

The Mayo Clinic recommends that it is important to always take blood pressure medications as prescribed and not skip a dose or suddenly stop taking them because they can have the adverse effect of causing a sharp increase in blood pressure known as rebound hypertension.⁸

For labile hypertension, out-of-office and home blood pressure monitoring is very important.⁷

Sometimes, blood pressure can remain high even when taking at least three different medications for hypertension, including a diuretic. This is known as resistant hypertension.⁸

Resistant hypertension needs your healthcare provider to check for possible second cause of the hyiertsnsion.⁸

Complications

The effect of chronic hypertension, that isthe persistent excessive pressure on the arteries can damage the arteries and organs. 

Complications it can cause include:

• Stroke( cerebrovascular accident) 
• Heart attack 
• Aneurysm
• Heart failure 
• Eye problems  resulting in vision loss 
• Kidney problem 
• Difficulty remembering things

When to seek medical attention

Hypertensive crisis, blood pressure of 180/120 mmHg require immediate consultation with your doctor. In the case of extreme crushing chest pain, it could be an indication of a heart attack. Call emergency service 911 immediately. 

Summary

Hypertension is persistent , sustained high blood pressure greater than 120/80 mmHg. 

It can be categorised as primary with no identifiable cause or secondary where causes can be identified. 

Sporadic or labile hypertension is when the blood pressure fluctuates rapidly and suddenly in a transient manner. White coat hypertension is a common example of labile hypertension where blood pressure rises only in a physician's  office/settings. 

Primary care providers and internal medicine specialists such as cardiologists or nephrologists are the major care providers in the management of hypertension. 

Hypertension can damage major organs such as the brain, kidneys, eyes, etc. 

Lifestyle modification and medication use are important ways of managing hypertension.