Orthostatic Hypertension

[giftcreations123]

hello

My cardiologist wants me to keep checking blood pressure and heart rate....we havent found any medications that seems to help or I dont react to...when sitting my blood pressure is low 85/ 60 and when I stand it increases.....

Do treatments differ if its hypotension...

Interestingly though, I

cant stand for long periods either , I feel like I will pass out...

Thank you

[arizona girl]

Hi gift! Dr. Grubb prescribed me labetalol for my orthostatic hypertension. It's an alpha beta and seems to have stopped the postural swinging. I'm still getting hypertensive when it starts to wear off, now regardless of position.

How high are you actually going? I'd get below the 100s on my BP and HR when I was laying down, it dropped when sitting, but not that low. What' going on with your heart rate posturally? Dr. Grubb says I have the hyperadregenic Pots, which is associated with orthostatic hypertension. Mine also goes up when I talk, does yours do that too! Did you have a tilt table test done yet? Mine showed orthostatic tachycardia and BP, with a sudden spike up that caused both HR and BP to suddenly drop causing syncope. So I did pass out, from standing to long. In real life I sit down or get to the ground before I actually get syncope. So yes, you can pass out from standing too long. I seem to be okay if I'm moving, it's the standing that gets me. Also motion triggers the episodes too like on an airplane, on a curvey road in a car, or a ride at a park, and heat and humidity and medical procedures do as well. If I avoid all those things then I'm pretty good Hope this helps you!

[janiedelite]

The older research for POTS describes the hyperadrenergic variety as being a rare subset of patients (less than 10%) whose primary problem is that their body produces too much adrenaline. Not very many POTS patients actually have this as their main problem. I only mention this type of POTS because treating these patients requires a totally different approach than treating the POTS associated with blood pooling.

I have also been described by my Mayo neurologist as being hyperadrenergic, but my main problem is neuropathy which causes my blood to pool improperly. My brain realizes it's not getting enough bloodflow, so it tells my body to produce more adrenaline in an effort to increase peripheral vasoconstriction and cardiac output, trying to get more bloodflow to my brain. My BP will go from 110/60 lying down up to 160's/110's standing. My pulse will go from 50 to 140, depending on how long I've been standing. Like arizona girl, I also have BP spikes while talking, and while I'm under stress. I also have problems with chronic frostbite because the excess adrenaline causes inappropriate vasoconstriction.

Since my excess adrenaline (also called norepinephrine) is produced as a normal response to my abnormal pooling, I can control my hypertension and hyperadrenergic symptoms somewhat by trying to control the pooling. I wear compression hose every day. I drink at least 3 liters of fluids and lots of salt. I try to strengthen my legs in order to improve my skeletal muscle pump. And I've started taking mestinon, which helps to selectively vasoconstrict when I'm standing. It also lowers my BP and heartrate. My symptoms are still too severe to allow me to work, but I've gone from being primarily bedbound to being able to clean the house, go out to eat, and I don't feel like I'm dying every moment.

[ramakentesh]

Orthostatic hypertension only occurs in a subset of POTS patients and is usually taken to be a sign of sympathetic excess as the primary functional problem. However this is still debated.

The theory is that in hyperadrenergic POTS a few different mechanisms can result in orthostatic hypertension either as a primary problem or as a consequence:

NET deficiency is ASSUMED to cause postural hypertension, increased heart rate, unapposed sympathetic activation and cerebral vasoconstriction - in other words your arteries are constricting only orthostatically, but to such a point that your brain is literally being chocked from blood flow. Carotid artery blood flow in these patients can be as low as 44% orthostatic. Norepinephrine (which Thankful is actually quite different from epinephrine/adrenaline) is assumed not to be uptaken at the synaptic cleft so it overactivates alpha and beta receptors.

There is maybe ONE or TWO doctors worldwide that would treat this presentation any differently than other forms - when they do they offer drugs that reduce sympathetic activity as a whole - not beta blockers, but combined alpha/beta blockers like labetolol, clonidine, methyldopa etc.

Other mechanisms can readily account for postural hypertension in situations where there is also paradoxically cerebral hypofusion. Venous pooling could account for it - but partial distal neuropathy is also a possibility - in certain parts of the body the vasculature is less sensitive to norepinephrine, so the body gets pumped with it to get it to vasoconstrict and the rest of the body - which is normal shows signs of excessive norepinephrine. Distal denervation could result in hypersensitivity of remaining receptors.

Some patients just seem overly sensitive to norepinephrine at normal levels - Low Flow POTS is an example where a biochemical mechanism results in hypersensitivity to norepinephrine in a way - normal levels, but over reaction - norepinephrine potentiation.

The final mechanisms is venous permiability - some subsets of hyper patients lose a lot of fluid from their stomach veins into surrounding tissue causing hypovolumia. Orthostatic hypertension could be a resultant mechanism to cope - and the thirst the other consequence.

Finally - if you have orthostatic hypertension how does your head feel when you lean forward - fill up with blood?

Mine and most do - which could be a possible sign of cerebral vasoregulation abnormalities. BTW - my BP can get to 180/100 when exercising. Due to the short term nature of this elevation and the paradoxical reduction in blood flow to the brain it is not perceived by my learned doctor as a health hazard.

[Mrs. Burschman]

Ramakentesh,

You are a resident expert on hyperadrenergic POTS. Can I ask a question? Does it always cause hypertension, or is it possible to have hyperadrenergic POTS with hypotension?

It certainly seems like I might have hyperadrenergic POTS. All of the symptoms fit, except for blood pressure. Mine is low. Very low, sometimes.

Thanks!

Amy

[toddm1960]

do you think it's blood filling our sinuses? When I sleep and lay on my right side, my right sinus is full and I can't breath out of that side. I'll roll over and the other side fills up. I do have my bed raised 6" but still fill up. Does everyone else have this problem?