Paroxysmal Hypertension Overview

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Hypertension is a medical term for high blood pressure. This is caused when your blood pushes against the walls of your arteries, and can be due to high cholesterol, clots or many other factors. Paroxysmal hypertension is also known as pseudopheochromocytoma. Dr. Samuel Mann of the Archives of Internal Medicine and Dr. Steven Wolfe says that paroxysmal hypertension always makes a doctor wonder if a catecholamine-secreting tumor is present. He also states that, normally, patients remain undiagnosed, which means they don’t receive treatment.

Symptoms

Symptoms include a fast onset or elevation of blood pressure that is more than 200/110 that a physician documents; and physical symptoms like headaches and chest pains, as well as dizziness and nausea, flushing and palpitations. The most common symptom is the lack of fear or panic in all patients. Episodes can last for as little as a half-hour, or as long as 12 hours, with episodes occurring anywhere from twice a day to once every few months. Between episodes, blood pressure is normal or slightly high.

Misconceptions

Many patients do not think that emotions play a part in this disease. Physicians need to review details of the patient’s psychotherapeutic history, suggesting that this disorder is directly related to emotions that patients do not realize they have. Dr. Mann states many of these patients have a history of severe emotional trauma or abuse.

Other Possible Diagnoses

There are other diseases that present in much the same way, including pheochromocytoma, labile hypertension and panic disorders. The pheochromocytoma has to be excluded in all patients with paroxysmal hypertension, and this can be done with urine catecholamines. Labile hypertension is found to be closely related to stress. People with panic disorders normally show fear and panic during an episode, and this would be a direct contradiction of symptoms of pheochromocytoma.

Causes

Anxiety and hyperthyroidism, as well as migraine headaches, all may cause of paroxysmal hypertension. Hypertensive encephalopathy, as well as coronary problems and central nervous system lesions associated with tumors, stroke and hemorrhage are other possible causes. Seizure disorders, carcinoid, tyrosine ingestion and baroreflex failures are all known causes as well.

Treatments

Successful treatments are possible, and use all of these in conjunction with one another or by themselves: antihypertensive agents, psychopharmacologic agents and psychotherapy. The antidepressant desipramine at 25 mg daily is a tricyclic serotonin inhibitor that works to help restore a normal quality of life. Beta blockers like atenolol or doxazosin have shown great success in helping to lower blood pressure drastically. Also, group or individual psychotherapy may help uncover underlying emotional issues that trigger the episodes.

Resource

Archives of Internal Medicine from the article Severe Paroxysmal Hypertension (Pseudopheochromoytoma)