Paroxysmal hypertension

As Pseudophäochromozytom (severe paroxysmal hypertension; hyperadrenerge essential arterial hypertension ) is called a syndrome, which is characterized by paroxysmal severe hypertension and in which a pheochromocytoma was excluded. The Pseudophäochromozytom is much more common than the pheochromocytoma. Such paroxysmal blood pressure increases are also observed after emotional stress and trauma. The treatment is then performed by psychotherapy, as well as a drug combination therapy, in the alpha - and beta- blockers, antidepressants, and anxiolytics as well be used.

Causes

In addition to emotional trauma, there are some other causes for the severe paroxysmal hypertension. Discussed, for example, that the obstructive sleep apnea syndrome could represent a rare cause.

Further, a connection with various drugs discussed, including clozapine and toloxatone, terbutaline, or phenylephrine.

Symptoms and Diagnosis

In patients with severe bouts of high blood pressure that are associated with distinct accompanying symptoms such as headache, chest pain, dizziness, nausea, heart palpitations, blushing and sweating, a pheochromocytoma should be suspected a stress hormone - producing tumor of the adrenal gland. In the vast majority of cases, a pheochromocytoma can be safely ruled out by determination of metanephrines in serum and / or urine.

The episodes are described as abrupt beginning, and be stressful emotions, anxiety or panic not triggered by stress. The attacks follow a half hour to several hours and can lead to a lasting two days exhaustion. The seizure frequency ranging from an episode in several months up to one to two episodes per day. Most of the blood pressure exceeds values ​​of 200/110 mmHg. Between attacks, the blood pressure is normal or slightly increased. In most cases the quality of life of people affected is significantly impaired.

Differential Diagnosis

• In patients with pheochromocytoma increased metanephrines found in serum and / or urine.
• In labile hypertension there is a relationship between blood pressure and stress or emotional stress situations.
• In a panic disorder anxiety and panic in the foreground, the increase in blood pressure is often not very pronounced.

Psychosomatic Basics

Through a psychosocial interview can often a past emotional trauma are revealed ( Holocaust, mental or physical abuse), without distressing emotions in the end associated with the trauma experienced. This suggests emotional defense mechanisms such as repression or dissociation. Can elicit no back -lying emotional trauma, can be found in affected often an attitude, be hardly noticed by the distressing emotions.

Therapy

Treatment consists of psychotherapy and medication by combined administration of alpha-and beta -receptor blockers, possibly in combination with an antidepressant and possibly an anxiolytic.