Labile hypertension: a faulty concept.

Labile hypertension is a phrase used originally to describe patients whose blood pressures were sometimes below and sometimes above 140/90 mm Hg. Lability of blood pressure, though not explicit, was implied by the phrase. There have never been good data to support this concept. The concept probably never would have developed had not the notion of a cut-off point (140/90 mm Hg separating hypertensives from normotensives) been so arduously propagated. These patients have no more lability of blood pressure than normotensive subjects or patients with fixed hypertension. They are now appropriately referred to as borderline hypertensives because their blood pressures fall between the clearly normotensive range and the clearly hypertensive range. Scattered within this group of borderline hypertensives are more patients with hemodynamic or humoral abnormalities, the significance of which is still not understood. Management of borderline hypertensive patients, with our without hemodynamic and humoral abnormalities, is conservative. Therapy must be individualized and is influenced by the average of multiple blood pressure readings, family history of hypertension, presence of concurrent cardiovascular risk factors, and presence of end-organ damage.