Abstract P108: The Cause and Treatment of Paroxysmal Hypertension

Abstract

Introduction: The cause and treatment of paroxysmal hypertension (PH) (“pseudopheochromocytoma”) in the 98-99% of patients who do not have a pheochromocytoma has long been a mystery. It has been linked to a psychosomatic origin based on the finding in nearly all patients of repression of emotions associated with either a past history of overwhelming stress or trauma or a repressive coping style. The purpose of this study is to convey further experience in understanding and treating PH. Methods: We reviewed the medical records of patients with a diagnosis of PH. Patients were considered to have PH if episodes were sudden in onset, were unprovoked (not precipitated by stress or anxiety) and were symptomatic (e.g., headache, flushing, tachycardia and/or others). Patient characteristics, psychosocial history and response to treatment were assessed. Based on the previous study, the psychosocial characteristics examined most closely were the presence of a past history of trauma or overwhelming stress, the emotional response to that trauma, the presence or absence of a history of depression or anxiety, and the presence or absence of a repressive coping style. Results: Sixty-eight percent of patients (24 of 35) reported a history of trauma with repression of related emotions; a repressive coping style was evident in 26% (9 of 35). Neither characteristic was evident in only 2 patients (6%). Most patients were prescribed clonidine and/or alprazolam for acute management of paroxysms; this intervention was considered sufficient by 10 (28%). Twenty-three of the remaining 25 were offered treatment with an antidepressant. Two refused and two could not tolerate an effective dose. Of the remaining 19, 17 (89%) responded, including 10 (53%) with complete cessation and 7 (37%) with reduction in frequency of paroxysms. The disorder resolved promptly without medication in 2 patients who gained awareness of emotions long held from awareness. Conclusions: The psychosocial history, the marked efficacy of antidepressant agents, and the rapid cure associated with gaining of awareness of previously repressed emotions strongly support the origin of PH in repressed emotions. To date, no other cause or effective treatment has been reported.