What Is Labile Hypertension?

Written by Deanna Altomara
Medically Reviewed by Poonam Sachdev on July 23, 2025
7 min read

Your blood pressure regularly rises and falls, but if it changes too much within minutes, this may be one of the signs of labile hypertension. Although there’s no exact definition, this is a condition where your blood pressure spikes more often than the average person.

 

You can think of blood pressure like water going through a hose. If the water comes out in a strong and fast flow, the pressure is high. If it comes out in a trickle, the pressure is low. Blood travels through the arteries in the same way.

A blood pressure reading has two numbers. The first number represents systolic blood pressure, which indicates the amount of pressure your blood puts on the walls of your arteries when your heart beats. The second number represents diastolic blood pressure, which indicates the pressure your blood puts on artery walls in between heartbeats.‌

Abnormalities in either of these readings can lead to a diagnosis of high blood pressure, but the systolic reading is often more important.‌

Having a high systolic reading puts you at a greater risk for cardiovascular disease over the age of 50. Your blood pressure naturally increases as you age because:

  • Your arteries become stiff.
  • Plaque‌ builds up in your arteries.
  • Your chances of getting cardiovascular diseases go up‌.

The American Heart Association outlines five stages of blood pressure: normal, elevated, hypertension stage I, hypertension stage II, and hypertensive crisis.‌

Normal blood pressure. A normal blood pressure reading is less than 120/80 mmHg. Here, “mmHg” stands for millimeters of mercury because the traditional blood pressure gauge — called a sphygmomanometer — contains mercury used for measurements.‌

Elevated blood pressure. Elevated blood pressure means a systolic reading between 120 and 129 and a diastolic reading below 80. If you get either of these readings, your doctor will ask you to manage your blood pressure to keep the condition from worsening.‌

Hypertension stage I. If your blood pressure consistently measures between 130 and 139 systolic or between 80 and 89 diastolic, you’re in hypertension stage I. Your doctor may recommend a specific diet and certain lifestyle changes to lower your blood pressure. If you have other cardiovascular risk factors, they may also prescribe a blood pressure medication at this stage before it worsens.‌

Hypertension stage II. If your blood pressure consistently measures 140/90 or higher, you’re in hypertension stage II. You’ll likely be prescribed a blood pressure medication at this stage.‌

Hypertensive crisis. If your blood pressure reading ever exceeds 180/120, your life may be in danger. As a precaution, make sure you measure it again in five minutes to see if it has become lower. If it still stays high, you may be in a hypertensive crisis, and you need to seek immediate medical attention.‌

Hypertensive crisis is typically accompanied by symptoms such as:

  • Chest pain
  • Shortness of breath
  • Back pain
  • Numbness
  • Weakness
  • Changes in vision
  • Difficulty speaking

The exact cause of labile hypertension isn’t clear, but doctors think it has to do with the sympathetic nervous system. This is the part of the nervous system that raises your heart rate and blood pressure. It may overreact to triggers like stress. Many people report that they get blood pressure spikes when they have strong emotions, such as fear or anxiety.

It’s normal for blood pressure to go up when you’re upset. But if it swings too high or too often, that could signal a problem.

Some medical problems can also cause blood pressure to spike more often than usual. These include:

  • Sleep apnea
  • Heart disease
  • Kidney disease
  • Adrenal problems

Medications such as tizanidine (a muscle relaxer) can also affect your blood pressure, says Wanpen Vongpatanasin, a professor in the Department of Internal Medicine at UT Southwestern Medical Center and Director of its Hypertension section. Other medications to watch out for include:

  • Nonsteroidal antiinflammatory drugs (NSAIDs), such as Advil and Aleve
  • Oral steroids
  • Drugs used to treat ADHD
  • Birth control pills

Your doctor can help you figure out what is causing your blood pressure to spike.

During a blood pressure spike, you might notice:

  • Headache
  • Pounding or fluttering heart
  • Flushing

Your doctor will give you a 24-hour ambulatory blood pressure monitor. This will collect regular blood pressure readings.

Remember the blood pressure readings from before? There’s no numerical cutoff for labile hypertension. Labile hypertension is simply the observation that your blood pressure is more “up and down” than the average person, says Samuel Mann, MD, professor of clinical medicine at Weill Cornell Medical College.

If there’s a spike for one or two readings and the rest is normal, you’re probably fine, he says. But if you see it’s up and down all day or a number of times in the day, you might want to ask your doctor about treatment options.

It can be hard to tell the difference between anxiety and labile hypertension. That’s because it’s normal for anxiety to cause blood pressure to temporarily go up. But thinking about how often anxiety causes blood pressure spikes and how severe the spikes are can help distinguish between the two.

For mild or occasional bumps in blood pressure, no treatment is necessary. But if you have other cardiovascular risk factors, if the spikes are frequent or severe, or if they are causing unpleasant physical symptoms, you might consider taking blood pressure medication.

Mann usually prescribes a combination of a beta-blocker and an alpha-blocker for patients with labile hypertension. Doctors usually avoid prescribing clonidine, an older blood pressure medication.

The tricky thing about treating labile hypertension is that while medication can lower a spike, it also brings down your regular blood pressure. But if your blood pressure dips too low, that can cause different problems. Your doctor can help you figure out if medication is a good choice for you and how much you can take.

An alternative option is antianxiety medication, says Mann. This can help control your emotions, leading to fewer spikes in blood pressure. Plus, it doesn’t carry the risk of making your blood pressure dip too low.

What conditions cause labile hypertension?

If you have an underlying medical condition that is causing blood pressure spikes, your doctor will treat that condition. Examples of such medical conditions include:

  • Sleep apnea
  • Cardiovascular disease
  • Kidney disease ‌
  • Adrenal gland problems‌

Blood pressure spikes can also be a sign of autonomic dysfunction, which is when your body has trouble regulating your temperature, heart rate, and breathing. If you have this problem, you need to see a cardiologist (heart doctor).

Many times, these conditions cause damage before you even realize it’s happening. So, it’s important to talk to your doctor about any concerns you have regarding your blood pressure.

With regular hypertension, your blood pressure is high all the time. But with labile hypertension, your blood pressure spikes often. Usually, this happens after a stressful event or strong emotion.

Over time, regular blood pressure spikes can take a toll on your heart. This can raise your risk for cardiovascular disease, says Mann.

Certain things can help keep your blood pressure from swinging. For example, avoiding salt may be a good idea, says Vongpatanasin. Salt can cause your arteries to stiffen, which makes it harder for them to regulate blood pressure and avoid spikes. (Picture water going through a lead pipe instead of a rubber hose — the stiff metal isn’t able to cushion the pressure as well.)

Exercise, on the other hand, can help arteries stay soft and flexible. Sometimes, people think that it will make their blood pressure rise, says Vongpatanasin. Aerobic exercise, such as walking or jogging, should reduce blood pressure and not make blood pressure spike. “I usually reassure them as long as they don’t go lifting a 300-pound weight,” they should be fine.

Blood pressure spikes can be triggered by stress or anxiety, so it might be a good idea to focus on your mental health. You can try managing these emotions with calming activities such as deep breathing, yoga, and journaling. Antianxiety medication also might help.

In general, it’s a good idea to contact your doctor if you have any concerns about your heart. Give them a call if you have occasional palpitations (pounding or fluttering heartbeat) and no other symptoms. If you have other symptoms (like feeling dizzy) or the palpitations suddenly get worse, see your doctor right away.

If you have a very high blood pressure reading at home, try relaxing for a few minutes before checking again. If it’s still abnormally high, get medical help.

Call 911 if:

  • Your blood pressure is 180/120 or higher.
  • You have chest pain or shortness of breath.
  • You have trouble walking, seeing, or speaking.
  • You are numb on one side of your body.
  • You faint.
  • You have pain, pressure, or tightness in your chest, jaw, arm, or back.

Labile hypertension is when your blood pressure spikes more than normal, usually because of strong emotions such as stress. There’s no set cutoff or definition of labile hypertension, and more research is needed to understand it. Depending on the severity and frequency of your blood pressure spikes, your doctor might recommend blood pressure or antianxiety medication.

What is the difference between labile and paroxysmal hypertension?

Labile hypertension is often caused by strong emotions, while paroxysmal hypertension usually isn’t.

Can labile hypertension be dangerous? 

It is very rare for labile hypertension to result in a cardiac emergency, as long as your blood pressure spike isn’t extreme and you don’t have any other conditions such as coronary heart disease or a history of stroke.