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What Can You Tell Me About Pots With Postural Hypertension?


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I just got my official diagnoses today and, naturally, starting to have a lot of questions. I know this could be three or more separate threads, but I'm hoping to get as much info as I can out of this one.

First of all I'm wondering if I should really be starting Midodrine when my bp appears to have risen during the TTT along with tachycardia. I was given very specific instructions for monitoring my bp so I won't let myself get in a dangerous situation. But, I certainly don't want to take something that might make me feel worse if even for a day. I have a two-year-old to take care of by myself during the day. Thinking now a weekend would probably be best to try it for the first time since my DH will be home.

OK, having said that I was looking over the Mast cell info with the links and found some stuff there that made references to hypertension with POTS. I read something about hyperadrenergic POTS vs. non-. I don't fully understand this. Is this why the nurse administered the nitroglycerin spray with 15 mins left of the TTT? -to test my hyperadrenergic response? My doc told me it looks as though I have the peripheral type of POTS which is the better to have (didn't say as opposed to what). I didn't ask him what that actually meant at the time because it was about 2:45 and we had been at the hospital since 8:30 that morning for the TTT. I guess I was eager to leave and happy to have a Dx finally. I also figured I could just go home and look up whatever I didn't understand, but not having as much luck as I anticipated. lol Go figure.

I will appreciate any info you have the time or energy to give me. Thanks for reading.

PS. Tried to edit my error in the title but didn't have access I guess. lol

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The postural hypertension associated with POTS is confusing. I think it usually relates to increased peripheral resistance rather than the opposite in the partial dysautonomia variety.

In some literature postural hypertension is referred to as the 'hyperadrenergic' variety of POTS. Ofcourse, it now appears that these patients encompass a spectrum that starts with abnormal renin/angiotensin activity, hypovolumia and increased stomach filtration, moves on to NET deficiency, and possible receptor hypersensitivity and a possible autoimmune variety.

And then there are patients who do not have sympathetic excess, but who have faulty parasympathetic responses that result in a similar presentation.

There are also patients with Mast Cell disorders who possibly have POTS as a secondary presentation of this but this is also still a little unclear.

And there are patients with impaired cerebral vascular control for which postural hypertension may be a compensatory reflex mechanism.

Sorry if this confuses things but sadly it is confusing.

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