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My BP always runs on the lower side, while my heart rate is high a good majority of the time. A little over a year ago my cardiologist put me on Zebeta (bisoprolol) and Florinef. The combo did wonders for me. Recently the Zebeta stopped controlling my tachycardia and anxiety ("adrenaline surges"). He has switched me to Bystolic. Anyone have any luck with this?

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I briefly took bystolic, but stopped when it did not help with the other ANS symptoms (tremor, shakiness, etc.) I have upright hypertension, and bystolic did nothing for that. It also gave me insomnia and a vicious morning headache...I think it lasted too long in my system. I went back to morning Propranolol.

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So, far so good with the porpranalol for me too. The Bystolic made me too tired and I just felt worse. But, of the 4 other beta blockers I tried it was the better of the 4. But, I'm really quite happy with what the propranalol is doing for me. I use .5mg in am and .5 around 3pm. It is helping with the upright BP and shakes and tremors. I just seem to feel better. My pulse is still too high with standing, but my heart doesn't feel like it's going to beat out of my chest. The tachy starts from a lower place and even though the rise is still 30 or more, it doesn't hurt so bad.

All you can do is try the bystolic, everyone reacts differently. It may work great for you. I tend to have they hyper POTS - so high bp's with standing.

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Just a quick follow up on the post about propranalol. I read today that they are discoverying that beta blockers (including propranalol) lower renin levels and because of that can cause rebound high blood pressure. I've noticed when the propranalol wears off my BP is really high upon standing and my tachy is worse than ever. I'm wondering if this is not so good after all. It seems to be making the situation worse when it wears off. I never had my bp be this high. When it's in my system, I feel better but let it wear off and BAM. I'm starting to think I may be making myself worse in the long run. I go back to the need of having the renin and aldesterone be higher - not lower like the beta blocker is doing. I've also noticed that I'm being more dehydrated with it. Anyone else notice this about the beta's?

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Bystolic at the 5mg dose is highly selective for beta 1 receptors in the heart and kidney. It also has nitric oxide stimulating, vasodilatory effects.

Propranolol is a non-selective agent, hitting beta 1 and beta 2. Beta 2 receptors are found, among other locations, in the blood vessels and actually cause vasodilation. By blocking beta 2, blood vessels become more constricted. Hence, the possible indication for migraines, though this is speculative since the cause of migraines is still debated. The net result is usually still a drop in blood pressure due to lowering of heart rate and renin/ aldosterone. However, beta 1 selective agents or mixed beta/ alpha agents may be better choices for those with hyperadrenergic POTS. Propranolol acts centrally which is why it is a good choice for anxiety, stage fright, and migraines.

It depends on the particular patient since we all metabolize drugs differently, but the advised dosing of the short acting propranolol is two up to 4 times daily. 5mg is the lowest dose and may be out of ones system more quickly. Raj and colleagues dose patients on 5-10mg bid to qid.

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Hello, I was on Mestinon and 5mg Bystolic with no problems. The bystolic did lower my HR and I had no reactions to it. Maybe because it was a small dose. I have hyperpots. The combo really helped, although I have temporarily stopped taking them, I am going back on as soon as I am ready to stomach the mestinon again!! I had taken propranolol years ago, which really did nothing. But that was before the mestinon. Good luck!

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