Beta Blocker Question

[giftcreations123]

Hi..

My internist feels a beta blocker would help with tachycardia ( I have an appointment with cardiologist soon) but I dot understand something. If it lowers blood pressure and us POTSers get low blood pressure, wont a beta blocker cause it lower more.

cant wait to find this all out..

thanks

[potsgirl]

In classic POTS, high blood pressure is usually the problem. Have you been diagnosed with POTS in a tilt table test (TTT)? Usually the criteria for POTS on a TTT is that your blood pressure goes up by 30 or more beats per minute when you go from lying to a standing position. What is your BP like at home when you try this? I can't take beta blockers, but it's because I have severe orthostatic hypotension, another form of dyautonomia, where my BP is too low, and gets really low when I stand (70/45).

Hope this helps...

Jana

[giftcreations123]

Hi..

The thought of doing the ttt is to much for me to handle. I know I get tachycardia when I stand, pick something up etc...My dr. had been monitoring bp as wellas heart rate. ..

y bp is usually in the 100's over 50's range with normal hr when sitting. When I get up my heartrate and bp increases. However, when I stand for a while, my bp lowers again.

I feel horrible in the mornings, and often feel dizzy, lightheaded ad woozy.

Thank you

[Lenna]

With POTS, it's not blood pressure that goes up when you stand; it's your heartbeat. Your heart rate goes up 30 or more beats per minute when you have POTS.

[ramakentesh]

In classic POTS, high blood pressure is usually the problem. Have you been diagnosed with POTS in a tilt table test (TTT)? Usually the criteria for POTS on a TTT is that your blood pressure goes up by 30 or more beats per minute when you go from lying to a standing position. What is your BP like at home when you try this? I can't take beta blockers, but it's because I have severe orthostatic hypotension, another form of dyautonomia, where my BP is too low, and gets really low when I stand (70/45).

Close but no cigar.

its the heart rate that goes up and not the blood pressure.

Some POTS patients experience a decrease in blood pressure when they stand along with the increased heart rate due to pooling in the legs or stomach or just everywhere. Others experience actual postural hypertension (that is a hyperadrenergic response).

its unclear whether this hypertension is a reflex or coping mechanisms to maintain blood flow to the brain which is reduced by pooling or whether its part of the problem (excessive vasoconstriction starving the brain).

Betablockers can make POTS patients with low BP and high BP worse because they lower blood pressure and by implication, blood flow to the brain which is already limited. They can also leave alpha receptors unapposed, worsening vasoconstriction. And they also inhibit the already out-of-whack renin system to compensate for POTS by increasing blood volume.

That being said while they make me dizzier, they are a must when my adrenaline system is churning like a storm! I tolerate them fairly well. Many hypers do.

If your more of a low blood pressure, pooling in feet and hands type, then expect less benefit and possibly intolerable side effects (even lower BP, etc).

As for Postural hypotension there is some hope - the norepinephrine precursor L-DOPS/Droxydopa is doing the trick I hear in all the trials.

[potsgirl]

Lenna,

THANK you for correcting me. I was thinking the right thing, but wrote the wrong one. I'm embarrassed! Blame it once again on the brain fog...

Thanks again!

Jana

[potsgirl]

I feel like an idiot. I DO know this, I just wrote the opposite of what I was thinking. Thanks to you and Lenna for clearing this up...Not one of my better moments!

[summer]

My BP is all over the map - high.... low.... normal... but it is often low, and when I tried a BB alone, it was too low and made me feel worse. When I finally saw the ANS doc he perscribed both a BB and Florinef, and in combination, they really help. I was not able to take either one alone.

Summer

[Darlene]

I have POTS and my blood pressure goes up whenI stand, and my heartbeat.

[ramakentesh]

Im the same, but a beta can make me even more dizzy - either because it leaves alpha-vasoconstriction unapposed or because it lowers blood pressure and thus blood flow to the brain.

[flop]

Hi,

some people with POTS tolerate beta-blockers very well, some get no benefit and some feel worse on beta-blockers. There isn't a good way of predicting how any one person will feel on a beta-blocker, if you don't try you won't know.

My cardiologist is in favour of using small doses of cardio-selective beta-blockers. He started me on 1.25mg of Bisoprolol and we gradually increased this to 2.5mg twice a day. Before starting Bisoprolol I was already taking florinef with water and salt to raise my BP. For me bisoprolol was a "magic pill" in that as soon as I started taking it I stopped fainting - I still had POTS symptoms but I wasn't falling on the floor any more. I had 12 months without any faints. I took the bisoprolol for almost 4 years but had to stop taking it because of worsening allergy problems.

The usual advice re medication in POTS - only change one medication at once (that way you know if it is helping or making things worse) and start off on a small dose (many of us seem to be more sensitive than usual to medications, starting low and building up can minimise the side-effects).

Flop