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Paradoxical Hypertension

In this form of hypertension, patients paradoxically show an increase in BP. even when on antihypertensive drugs
  • Patients with DM and HTN, on beta blockers, on developing hypoglycacmia show a paradoxical risen over previously well-controlled BP. This is because the excess adrenaline released secondary to hypoglycacmia. This will acts unopposed on the alpha  receptors and thereby raises the BP.
  • With high doses of clonidine, the peripheral a, receptors are stimulated, apart from its central action, thereby raising the BP.
  •  In patients with bilateral renal artery stenosis, administration of ACE inhibitors, results in a paradoxical rise in BP.
  • Administration of P blockers in patients with pheo- chromocytoma leads to uninhibited a receptor stimulation by epinephrine leading to paradoxical rise in BP.
Paradoxical hypertension is seen in
  • Diabetics on beta blockers
  • Phaeochromocytoma on beta blockers
  • High doses of clonidine
  • ACEI in bilateral renal artery stenosis