Depression masked as paroxysmal hypertension episodes

This paper describes a clinical picture frequently seen in specialty hypertension clinics, a patient with paroxysmal or intermittent hypertension not related to pheochromocytoma. A variety of diagnostic labels given to these patients is reviewed, including pseudopheochromocytoma and panic attacks. The clinical features, pathophysiology, diagnosis and treatment of these syndromes are outlined. It is proposed that successful management of these patients may be best achieved by collaborative care between a hypertension specialist and a psychiatrist, or clinical psychologist with expertise in cognitive-behavioral panic disorder management, stress-reduction techniques including controlled breathing, and effective treatment of anxiety. The use of drugs effective for treatment of panic disorder can also be helpful in managing those patients.