Understanding Labile Hypertension

‘Hypertension’ is another term for high blood pressure. Labile hypertension is a specific form of the condition that requires extra consideration in its treatment.

In this article, we'll explain what labile hypertension is, and how your doctor will likely diagnose and treat it. 

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What is labile hypertension?

Your blood pressure refers to the amount of pressure your blood exerts on the walls of your blood vessels as it travels through your body. There are two numbers used to measure this pressure: systolic and diastolic.

Systolic is the top number and measures the pressure of blood as it is released from the heart. The bottom number, diastolic, measures the blood pressure when the heart is filling with blood to be pumped. The numbers are measured in units called ‘millimeters of mercury’ (mm Hg).

Doctors use various stages to describe a person's level of hypertension:

  • Normal: A person without hypertension will have a blood pressure reading lower than 120mm Hg systolic and lower than 80mm Hg diastolic.

  • Elevated: When the systolic number is 120–129, but the diastolic reading is lower than 80, it is considered elevated blood pressure. Medical intervention isn’t usually needed at this point, but the doctor will likely ask you to make diet and lifestyle changes to reduce that number.

  • Stage I: A systolic number of 130–139 or a diastolic number of 80–89 represents stage I hypertension. At this level, the doctor may prescribe medication in addition to asking you to make diet and lifestyle changes.

  • Stage II: With a blood pressure reading over 140 systolic and 90 diastolic, medication is more likely to be prescribed to get things under control. Readings this high indicate stage II hypertension.

  • Hypertensive crisis: If blood pressure readings go over 180 systolic or 120 diastolic, it's referred to as hypertensive crisis. As the name implies, this is a dangerous condition. If readings stay at those levels for more than a few minutes, medical attention is necessary.

While there is always some fluctuation in blood pressure throughout the day, most people with hypertension have reasonably consistent blood pressure. This makes it easy for doctors to find the right dosage to reduce the pressure to a safe level.

People with labile hypertension, however, experience far more dramatic swings in blood pressure. They don't easily fit into either the normal or the hypertensive category, and can jump from normal to stage II and back. This unpredictability complicates efforts to control the condition.

What causes labile hypertension?

There are a few things that might cause your blood pressure to spike temporarily. Often, one of these known causes is at the root of labile hypertension. Other times, the exact cause is unknown.


Anxiety or stress can raise your heart rate and, as a result, your blood pressure. Interestingly, some people get so nervous about having their blood pressure taken that the readings are higher than they should be. This is known as ‘white-coat syndrome.’ 


One of the effects caffeine has on the body is to increase the heart rate. Just like stress and anxiety, this increase can raise your blood pressure. It's been shown¹ that blood pressure does indeed rise for a brief period after the consumption of caffeine.


Non-steroidal anti-inflammatory drugs are a common class of pain killer that includes aspirin, ibuprofen, and naproxen sodium. The use of these drugs has been shown to increase² blood pressure.

Misleading readings can also occur due to incorrect use of a blood pressure monitor. These types of problems often occur at home when the user isn't aware of the proper procedures for taking their blood pressure. Incorrect readings can result from using an improper cuff size or not resting before taking a reading.

How is labile hypertension diagnosed?

Hypertension itself is well defined. Depending on your readings, doctors can use an objective measure to place you in one of the hypertension stages mentioned previously.

Such objective measures for labile hypertension do not exist.³ There's no set amount that your blood pressure needs to jump or drop in a certain time to be diagnosed with the condition, and certainly no objective criteria for measuring its severity.

To better understand how your blood pressure is fluctuating, your doctor may ask you to use an over-the-counter blood pressure monitor to record your blood pressure throughout the day. They may also ask you to use a special medical device that records blood pressure at short intervals throughout the day called a 24/7 ambulatory blood pressure monitor.

How is labile hypertension treated?

Medication can be used to treat sustained hypertension. Labile hypertension can be much less predictable and make it harder for a doctor to find the right dose. If the blood pressure is frequently normal, blood pressure medicines might lower it too much. What’s more, such medication doesn't appear³ to reduce blood pressure variability.

Because stress is often a cause of labile hypertension, your doctor may equip you with stress management tips to help you reduce your stress levels. If your anxiety is bad enough, this may include anti-anxiety medications to help you maintain a more consistent mood.

Common techniques for lowering blood pressure may also help keep your blood pressure spikes in a safer range. There are quite a few diet and lifestyle changes you can make that will help to lower your blood pressure. 

Dietary changes

Most people don't have a very healthy diet. Modern diets are often filled with processed foods high in substances that are not nutritious. These foods can contribute greatly to elevated blood pressure readings.

In addition, our diets often lack some of the important nutrients that help our bodies better regulate blood pressure. Let's take a look at some of the changes you can make to your diet to reduce your blood pressure.


Many of the staples in a modern diet are bad for your high blood pressure. Any reduction in these elements will help to lower your blood pressure.

You can discuss your specific case with your doctor to see how drastically you should alter your diet, given the frequency and intensity of your blood pressure spikes. 

  • Sodium: One of the substances most associated with high blood pressure is sodium. The CDC estimates that 11 million cases of high blood pressure could be eliminated annually if everyone stayed under 2,300mg of sodium per day. Unfortunately, some processed foods can contain close to that in a single serving. Because the average person consumes over 3,400mg per day, cutting sodium is a great place to start.

  • Sugar: Studies⁴ have shown that a decrease in sugar intake can reliably predict a decrease in blood pressure. Many of the drinks we consume are high in added sugar. Often, this sugar comes in the form of high fructose corn syrup, which is also known⁵ to raise blood pressure. Reducing sugar helps reduce weight, which can also lower blood pressure. However, sugar can negatively affect your blood pressure independently⁶ of any weight gain.

  • Red meat: Swapping out red meat for white meat can also help to reduce your blood pressure. One study⁷ showed that an increase in red meat can reliably predict an increase in systolic blood pressure. If you love red meat, there is some good news. A meta-analysis⁸ of controlled trials found that up to a half serving of red meat a day can be consumed with no effect on blood pressure. 


Controlling blood pressure through diet isn't all about what you cut out. There are also plenty of foods and nutrients known to have a positive impact on blood pressure readings. Adding more of these foods and nutrients to your diet can help counterbalance the remaining unhealthy foods that you eat.

  • Potassium: Potassium works with sodium in the body, and has the opposite effect of sodium. Increased amounts of potassium are associated⁹ with decreases in blood pressure. While potassium is present in many foods, the use of sodium in processed foods means that most people get more sodium than potassium. Most salt substitutes are made with potassium chloride, which can be a good way to raise potassium intake while decreasing sodium intake.

  • B vitamins: Several of the B vitamins help reduce blood pressure. B2 (riboflavin) has been shown¹⁰ to lower blood pressure in certain population groups. B9 (folate) is also associated¹¹ with lower blood pressure levels. Another study¹² looked at B2, B6, and B9 in combination and found that they work to lower blood pressure.

  • Vitamin D: It has been established¹³ that having a deficiency of this vitamin can increase the likelihood that a person develops hypertension. It remains to be seen whether additional vitamin D beyond the required amount will actually lower blood pressure. Because vitamin D is largely made by the body from exposure to sunlight, those with limited exposure might benefit from higher dietary vitamin D or supplementation. 

  • Beetroot: An extensive review¹⁴ of available studies on the effectiveness of beetroot shows overwhelming evidence that food has a positive role to play in lowering blood pressure. The studies showed the greatest reduction in blood pressure for those who were hypertensive, though blood pressure was reduced for those without hypertension as well.

  • Garlic: A review¹⁵ of the literature surrounding the use of garlic for reducing blood pressure showed that garlic supplements can be effective. For the studies where no effect on blood pressure was shown, researchers hypothesize that deficiencies in other nutrients, such as B vitamins, were to blame. Speak to your doctor about whether garlic is a good option for you.

  • Omega 3: This fatty acid found mostly in seafood has been shown¹⁶ to have an effect on lowering blood pressure. Most of the studies were conducted with diets high in foods that contain omega 3 fatty acids. For those who don't eat seafood, omega 3 is readily available in supplement form, often sold as fish oil tablets.

  • Green tea: Although researchers caution that more studies are needed to fully understand the effect that green tea has on blood pressure, it was shown¹⁷ in short-term studies to reduce both systolic and diastolic levels. Freshly brewed green tea is the best option, as some of the pre-packaged options may be loaded with added sugar.

Lifestyle changes

Taking steps to eat more healthily will certainly have a positive impact on people with higher-than-normal readings and could potentially help to prevent spikes from getting too high for those with labile hypertension.

Because stress is often a key factor in labile hypertension, certain lifestyle changes may have an even more profound effect on preventing the spikes.

Stress management

Stress doesn't just increase the chances that you'll see a spike in blood pressure from labile hypertension. It also has several negative effects on your well-being, including an increased risk of heart disease and stroke.

To help reduce those risks, the American Heart Association has dedicated an entire section of its website to stress management.¹⁸


Another great way to deal with both high blood pressure and stress is exercise. Regular exercise that gets the heart pumping is known to reduce high blood pressure, as well as the risk of heart disease, stroke, and other adverse medical conditions.

As a bonus, exercise also reduces the symptoms of depression and anxiety.

The lowdown

Having high blood pressure can be stressful. For some people, it's so stressful that the mere act of taking a blood pressure reading can raise their blood pressure. But that isn't the only time stress raises blood pressure.

People who deal with stress frequently may find that their blood pressure fluctuates between normal and very high. This type of extreme fluctuation in blood pressure readings, regardless of cause, is known as ‘labile hypertension.’ Your doctor can tell you whether your spikes are high enough and frequent enough for you to be concerned.

  1. The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: A systematic review and meta-analysis (2011)

  2. NSAIDs and increased blood pressure. What is the clinical significance? (1997)

  3. The clinical spectrum of labile hypertension: A management dilemma (2009)

  4. Added sugar intake is associated with blood pressure in older females (2019)

  5. Effects of high fructose corn syrup and sucrose on the pharmacokinetics of fructose and acute metabolic and hemodynamic responses in healthy subjects (2012)

  6. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome (2015)

  7. Relation of iron and red meat intake to blood pressure: Cross sectional epidemiological study (2008)

  8. Total red meat intake of ≥0.5 servings/d does not negatively influence cardiovascular disease risk factors: A systemically searched meta-analysis of randomized controlled trials1,2 (2017)

  9. The role of potassium and sodium in your diet | Center for Disease Control and Prevention

  10. Riboflavin lowers blood pressure in hypertensive people with the MTHFR 677TT genotype (2014)

  11. A meta-analysis of folic acid in combination with anti-hypertension drugs in patients with hypertension and Hyperhomocysteinemia (2017)

  12. Effectiveness of B vitamins on the control of hypertension and stroke events of SHRSP rats (2010)

  13. Association between vitamin D and hypertension in people coming for health check up to a tertiary care centre in South India (2019)

  14. Functional properties of beetroot (Beta vulgaris) in management of cardio-metabolic diseases (2020)

  15. Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis (2020)

  16. Long-chain omega-3 fatty acids Eicosapentaenoic acid and Docosahexaenoic acid and blood pressure: A meta-analysis of randomized controlled trials (2014)

  17. Effect of green tea supplementation on blood pressure (2020)

  18. Stress management | Heart Attack and Stroke Symptoms

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