Labile and Systolic Hypertension: A Reappraisal

As contrasted with diabetes, in which lability is a serious liability, lability in hypertension is generally viewed as a mitigating factor. Labile hypertension has long been regarded either as a relatively benign manifestation of an exaggerated response to stress or, at worst, as a possible prelude to "fixed" hypertension. Most clinicians thus tend to disregard a single casual elevated blood pressure (BP) reading in favor of a normal basal pressure obtained when the patient is relaxed. Similarly, most epidemiologists exclude the labile variant from their studies on hypertension. In their report on a 20-year biennial follow-up study of a Framingham cohort of 5,209 men and women, Kannel et al1cast serious doubts on the innocuousness of labile hypertension. Indeed, they challenge the concept of labile hypertension as a separate entity. In their study, nearly all patients with hypertension demonstrated lability; in fact, the more severe the hypertension, the greater