Hypertension: labetalol may increase blood pressure in phaeochromocytoma.

Clinical bottom line (level 4)

  1. In phaeochromocytoma, there may be a paroxysmal increase in blood pressure with labetalol.
Briggs et al: Lancet 1978; 8072: 1045-1046
Expires December 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, UK

1 patients (aged 55 years old, 100% female) phaeochromocytoma, diagnosed histologically. Blood pressure was on average 180/ 100 mg, and there were no significant changes with posture or paroxysmal fluctuations. The highest blood pressure was 210/ 120 mmHg. Plasma adrenaline and noradrenaline were raised.
100 mg labetolol at 8 hour intervals, was given three times


Outcomes studied:

The evidence


  • blood pressure after investigations:
    • supine: 210/ 110 mmHg
    • standing: 200/ 115 mmHg
  • blood pressure 8 hours after first 100 mg labetolol:
    • supine: 230/ 115 mmHg
    • standing: 130/ 100 mmHg
  • blood pressure 8 hours after second dose of labetalol:
    • supine: 190/ 105 mmHg
    • standing: 170/ 100 mmHg
  • blood pressure 30 minutes after third dose of labetolol:
    • supine: 300/ 160 mmHg
    • standing: 140/ 90 mmHg
  • The patient was given 5 mg phentolamine iv, and within two minutes her supine blood pressure fell to 150/ 95 mmHg. Control was maintained with phenoxybenzamine.

Comments

  1. Case history of just one patient. Note it is unusual to find case reports which demonstrate the 'expected' responses, and so such reports may be found in the literature without published refutation.

Citation

  1. Briggs RS, Birtwell AJ, Pohl JE: Hypertensive response to labetalol in phaeochromocytoma. Lancet 1978; 8072: 1045-1046
Contributor: Clare Wotton and Bob Phillips, December 2000
Reviewer:

Clinical Question.
Patient phaeochromocytoma
Intervention or Exposure labetalol
Outcome hypertensive response