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Bp Confusion

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When ever this happens I need to have it reexplained to me...some weeks my bp is consistently low. Other weeks it is very high. This variance in bp confuses me every time. I understand the low bp - that's what got me here in the first place (pass in car). I understand the high bp - I have had that since having kids. But why both and why so variable? Anyone understand this better? The problem is how to best medicate for this.... the betablockers can make me run low, the florinef can make me fun high...ugh


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When a patient has the answer to that question they would be in a much better position to treat their version of POTS.

My blood pressure increases always when i stand and normalises towards the end of the day when i start to feel better. I dont have bad POTs all the time - only in boutes which generally seemed to be triggered by overdoing things, certain environments or longhaul flying (my worst trigger by far for some reason).

It has been theorised that in some forms of POTS there is a persistant vasoconstrictive state caused by elevated sympo-excitation. The two current theories - one proven, one still to be proven - are 1. elevated angiotensin II increases sympathetic activity and thus the response to standing while simultaneously decreasing the availability of neuronal nitric oxide so that its a double vasoconstriction occuring - 2. impaired reuptake of norepinephrine - when you stand the body shoots of norepinephrine to vasoconstrict but because clearance is impaired in this theory, the norepinephrine stays within the synaptic cleft, increases nerve transduction and overconstricts, increases the heart rate, blood pressure and a host of other symptoms.

In both these low flow states, blood pressure would rise when standing always - and due to excessive cerebral vasoconstriction may cause dizziness, lightheadedness and visual disturbances. Postural hypocapnia may also develop. htis may also effect the vagus nerve and the baroreceptors although this is still debatable.

In other forms of POTS or should i say other suggested forms of POTS the blood pressure is a compensatory mechanism - a reflex sympathetically mediated increase to counteract blood pooling.

Its important to realise that blood pooling may occur in all forms of POTS for various reasons - and in hyperadrenergic states this pooling may even further increase symptoms.

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