What Is Labile Hypertension?

When your blood pressure fluctuates

Blood pressure is the pressure exerted on the walls of the arteries during the heart's cycle. Blood pressure normally changes throughout the day depending on time of day, food intake, physical activity, alertness, hydration, and stress.

When blood pressure on the arteries is consistently high, is it diagnosed as hypertension. Labile hypertension is a condition in which sudden, significant rises in blood pressure occur. At times the blood pressure can be normal, and at other times it is significantly elevated.

This article discusses labile hypertension, as well as its symptoms, diagnosis, and treatment.

Doctor checking patient's blood pressure

Terry Vine / Getty Images

What Is Labile Hypertension?

Hypertension is a common condition that affects half of all adults in the United States. In adults and children age 13 and older, a normal blood pressure is less than 120/80. Hypertension is diagnosed when blood pressure is consistently 130/80 or higher.

Having high blood pressure increases the risk of:

Labile hypertension, or labile blood pressure, is a condition in which blood pressure rises significantly and suddenly. Readings in the same day can vary widely.

Labile hypertension is a descriptive term to describe this phenomenon, and currently no definition with numerical cutoffs exists. However, blood pressure lability is important in that it can indicate a higher risk of complications and even point to specific underlying causes of high blood pressure.

Studies have demonstrated that blood pressure variability is associated with a higher risk of complications. A large study of over 2.8 million people in the Veteran Association healthcare system showed that higher blood pressure variability was associated with higher rates of death, coronary disease, stroke, and end state renal disease.

Similar Conditions

White Coat Hypertension

Some people have high blood pressure measurements at their healthcare provider's office but normal blood pressure measurements at home. The blood pressure cuff used at home must be checked to ensure it is giving accurate and not falsely low readings.

People with white coat hypertension have a lower risk of complications than people with a diagnosis of hypertension. If home measurements are truly, consistently normal, medication is not necessary. Instead, treatments may include lifestyle changes and monitoring.

Masked Hypertension

Masked hypertension can be considered the opposite of white coat hypertension.

In masked hypertension, blood pressure measurements at the healthcare provider's office are normal, but those at home are elevated. This is called "masked," since the normal readings at the healthcare provider's office can lead to missing a diagnosis of high blood pressure.

Studies have shown that blood pressure measurements at home are more predictive of future complications like heart attacks, stroke, and damage to kidneys. When home blood pressures are consistently elevated, lifestyle changes and medication are recommended.

Paroxysmal Hypertension

Paroxysmal hypertension is an older hypertension type concept. It is characterized by severe fluctuations in blood pressure thought to be due to activation of the sympathetic nervous system in response to repressed emotion.

The sympathetic nervous system is responsible for the "fight or flight" response by releasing the neurotransmitters catecholamines. Through the release of these neurotransmitters, the body responds in multiple ways to deal with the perceived stress. The heart beats more quickly and forcefully, and blood vessels constrict in response to sympathetic activation.

The syndrome of paroxysmal hypertension is known as "pseudopheochromocytoma," because the sudden hypertension mimics a catecholamine-secreting tumor, called pheochromocytoma, when no such tumor exists.

Labile Hypertension Symptoms

Labile hypertension may not present with any symptoms. However, some symptoms may include:

  • Intermittent headaches
  • Flushing
  • Palpitations
  • Shortness of breath
  • Fatigue


Labile blood pressure can be caused by a number of things, including:

  • High salt meals, particularly for people who are sensitive to salt intake
  • Stress or increased emotion (which increases the sensitivity of the blood vessels)
  • Excessive alcohol use
  • Cocaine use
  • Medications like decongestants
  • Certain eye drops
  • Anxiety that leads to checking blood pressure multiple times a day
  • Not taking blood pressure medications every day as prescribed
  • Pain

Often, the exact cause of labile hypertension cannot be identified.


There is no formal diagnostic criteria for labile hypertension since it is more of a descriptive term than a separate diagnosis.

Hypertension can be diagnosed with blood pressure measurement both in and out of a healthcare provider's office.

Blood pressure can be measured intermittently at home with a standard automatic blood pressure cuff or with ambulatory blood pressure monitoring.

Ambulatory Blood Pressure Monitoring

In ambulatory blood pressure monitoring, a cuff is worn continuously for a period of time, such as 24 to 48 hours. The cuff automatically measures blood pressure intermittently throughout the day and night. This type of monitoring can be particularly helpful for the diagnosis of white coat hypertension and masked hypertension.


Treatment of labile blood pressure can be challenging, since it is continually fluctuating.

All people with high blood pressure should make lifestyle changes to lower blood pressure, including:

  • Eating a healthy diet
  • Limiting salt intake
  • Exercising
  • Avoiding excess alcohol use
  • Avoiding medications that trigger high blood pressure
  • Supplementing with potassium

It's also important to address underlying reasons that can contribute to labile blood pressure. Stress management is important, and some people can benefit from techniques to reduce acute stress, such as breathing exercises.

Many people with high blood pressure will require blood pressure lowering medication, including ACE inhibitors, diuretics, beta blockers, calcium channel blockers, and more.

People with labile blood pressure sometimes develop dizziness and lightheadedness if their blood pressure is lowered too much when taking certain antihypertensive medications. This can be challenging and requires working with a healthcare provider to adjust blood pressure regimen.

Switching to a different medication, adjusting dosages, or taking medication at different times in the day (such as at night instead of in the morning) can be helpful. Changes should only be made under the guidance of your healthcare provider.


Labile hypertension is a phenomenon in which blood pressure fluctuates widely on different measurements. This blood pressure variability can increase the risk of certain complications and may be challenging to treat.

A Word From Verywell

Labile hypertension can be challenging to manage, especially when spikes or dips in blood pressure cause symptoms. Your healthcare provider will work with you to find a treatment regimen that works to keep your numbers under control.

If you use a blood pressure cuff at home to measure blood pressure, it's very helpful to bring the cuff to a healthcare provider visit to ensure the readings are accurate. Try to avoid checking blood pressure more often than recommended, since checking too frequently can cause additional stress, resulting in more elevated blood pressure readings.

Frequently Asked Questions

  • What are some tricks to lower blood pressure instantly?

    Taking medication as prescribed is the best way to lower blood pressure quickly. Beyond that, no magic bullets have the same immediate effect. However, if blood pressure is elevated because of an acute stressor, it can be helpful to perform breathing exercises to offset the effects of the sympathetic nervous system.

  • How often should I check my blood pressure at home?

    Most people do not need to check their blood pressure multiple times per day. If hypertension is newly diagnosed or blood pressure medications have been recently adjusted, a healthcare provider may recommend checking blood pressure a couple of times a day over a period of time to ensure that blood pressure is at its goal.

  • What is the best way to check blood pressure at home?

    Blood pressure should be checked while in a relaxed state, sitting still, with legs uncrossed and feet on the floor. The arm should be resting on a table at the level of the heart. Blood pressure should not be checked when feeling anxious, while having significant pain, or soon after smoking, eating, or exercising since these can affect measurements.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Heart Association. The facts about high blood pressure.

  2. Gosmanova EO, Mikkelsen MK, Molnar MZ, et al. Association of systolic blood pressure variability with mortality, coronary heart disease, stroke, and renal disease. J Am Coll Cardiol. 2016;68(13):1375-1386. doi:10.1016/j.jacc.2016.06.054

  3. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127–e248. doi:10.1016/j.jacc.2017.11.006

  4. Anstey DE, Pugliese D, Abdalla M, et al. An update on masked hypertensionCurr Hypertens Rep. 2017;19(12):94. doi:10.1007/s11906-017-0792-4

  5. Mann SJ. Severe paroxysmal hypertension (Pseudopheochromocytoma)Current Science Inc. 2008;10(1):12-18. doi:10.1007/s11906-008-0005-2

  6. Sanidas E, Grassos C, Papadopoulos DP, et al. Labile hypertension: a new disease or a variability phenomenonJ Hum Hypertens. 2019;33(6):436-443. doi:10.1038/s41371-018-0157-8

By Angela Ryan Lee, MD
Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.