This paper reviews the limited literature on paroxysmal hypertension. A case report describes the clinical picture frequently seen in specialty hypertension practice, a patient with paroxysmal or intermittent hypertension who proves not to have a pheochromocytoma. The variety of diagnostic labels given to these patients is reviewed, including pseudopheochromocytoma, panic attacks, and hyperventilation syndrome. The clinical features, pathology, 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 management, stress-reduction techniques including controlled breathing, and treating health anxiety. The use of drugs effective for treatment of panic disorder can also be helpful in managing these patients.