Perhaps the most challenging of blood pressure disorders to diagnose and treat, highly variable blood pressure poses numerous challenges to the clinician. Patients with exceedingly variable BP often have symptoms at varying times related to high blood pressure (headaches/sweats/palpitations) and low blood pressure (faints/lassitude/light headedness). There are several important causes of this disorder as follows:
- Atrial Fibrillation which can be paroxysmal
- Renal artery stenosis
- Endocrine (Phaeochromocytoma)
- Autonomic dysfunction
- Use of drugs that interfere with blood pressure regulation
The formal investigation of this problem often requires great expertise in autonomic assessment as well as familiarity with uncommon causes of hypertension. Such testing is not commonly available and many doctors do not even have access to an autonomic testing facility. `in order to improve his approach to the care of such patients, Dr Lobo has set up his own dedicated autonomic and haemodynamic testing laboratory at St Bartholomew’s Hospital where detailed testing takes place every week and a multidisciplinary discussion of the test findings enables him to select the best therapy for the patients thereafter.