Can Hyperadrenergic Patients Have Low Bp?

[Gemma]

Hi. I am a little confused. My neurologist said that based on testing and symptoms I mostly fit a hyperadrenergic POTS. I thought patients with hyperadrenergic POTS had high BP upon standing, mine drops upon standing. So, my question is can person with hyperadrenergic POTS have low standing BP?

When I stand it usually drops to 85-95/50-65. My sitting is 105/55-65. But sometimes i could have standing 112/70 or so after I do some activity, but this is very rare BP reading for me but does happen.

Please help me understand why the doctor suggests I have hyperadrenergic POTS. All autonomic testing within normal limits; blood volume a little elevated, red blood cells a little low, plasma a little elevated, qsart negative. But my catecholamines (NE) is elevated standing and normal laying down.

Thank you all.

[Freaked]

It could be that if you didn't have hyperpots, your standing bp would be even lower, since your sitting bp is quite low.

[Gemma]

Hi Freaked. Sorry I didnt really understand you reply. So, can patients with Hyperadrenergic POTS have low blood pressure. I was always under impression that they supposed to have increase in BP upon standing, but mine actually goes down. Usualy sitting systolic is like 105 and standing is like 85-90.

I think low BP runs in my family. I measured it on my mom and her sitting is same as mine, maybe 110 and standing is in 90s as well. However, her HR doesnt jump like mine and standing is in 70s, but mine goes above 100s.

[yogini]

I thought one of the key symptoms of hyper POTS was an increase in BP upon standing. If this is the case, it doesn't sound like you have hyper POTS. I would ask your dr why he/she thinks you have it. Apart from a handful of POTS specialists in the country, I think most doctors get confused about the terminology.

[Gemma]

Yes i will call him next week and ask, because it doesnt sound like what I have.

[Chaos]

I know my POTS specialist originally said he thought I had neuropathic POTS with a hyperadrenergic component. He says a true hyperPOTS patient wouldn't have the low BPs I have and yet I have a lot of the other symptoms of a hyperPOTS patient, including the increased catecholamines. Over the years I've been seeing him, he's gone back and forth on what type(s) I have and now he just throws up his hands and says he doesn't know what kind of POTS it is.

I think this is where some of the terminology can be less than clear and different docs mean different things when they use the same terms. Also, some patients do seem to have symptoms that cross over the boundaries of the various types. Until they can clearly define the sub-types by labs or some other objective measurements, this confusion is likely to continue.

[Freaked]

I seem to have hyperpots and I go through phases where my standing bp is lower and phases where my diastolic gets pretty high. If you have the raised catecholamine levels, that's really the main indicator, I thought.

[Gemma]

Hi girls. Thanks for answers. My catecholemines did go up upon standing. Laying down it was within range, but on standing my Epi went down a little and my NE went to like 786 i think, above 600 norm. So, based on this doctor is saying hyper, but my BP very rarely goes up on standing, it actually always drops systolic by like 15-20 points.

I am just getting confused with the whole concept. So, NE is more like a stress hormone, so when its realized it should constrict blood vessels and this way BP should go up and HR should stabilize. So, I do not understand how could I have increase in NE and have drop in BP. Thats interesting.

But you all say that the definite test is the blood catecholemines to know if hyper, right?

Can I also ask. Are SSRI good for people whose NE elevated upon standing? Or SNRI?

Thank you.

[yogini]

I think you can have low/lower BP with hyperpots, but one of the key symptoms is a large increase of BP upon standing.

Many dysautonomia patients (like me!) tend to have orthostatic hyoptension - meaning your BP drops upon standing, but hyperpots is characterized by orthostatic hypertension, meaning an increase. See this description from a Dr. Grubb article. It is interesting to me that this is a less common form of POTS. So many people on the forum talk about hyperPOTS that I assumed it was more common!

The second (and less common) form of primary POTS is referred to as the "hyperadrenergic" form. These patients tend to report a gradual and progressive onset of symptoms as opposed to an abrupt onset. Hyperadrenergic POTS patients report significant tremor, anxiety, and cold sweaty extremities when upright. Many will report a significant increase in urinary output after being upright for even a short period of time, and over half suffer from true migraine headaches. The hallmark of this form of POTS is that in addition to orthostatic tachycardia they will often display orthostatic hypertension, as well as exaggerated response to isoproterenol infusions. As opposed to the PD POTS patients, the hyperadrenergic patients have significantly elevated serum catecholamine levels with serum norepinephrine levels >600 ng/mL. There is often a family history of this disorder. Currently, hyperadrenergic POTS is felt to be a genetic disorder, in which a single point mutation produces a dysfunction of the re uptake transporter protein that clears norepinephrine from the intrasynaptic cleft. This in turn leads to excessive degree of norepinephrine serum spillover in response to a variety of sympathetic stimuli thereby producing a "hyperadrenergic" state that appears similar to a pheochromocytoma.

[kitt]

You can have a decrease of BP on standing and still have hyperadrenergic pots. You can also have a decrease of BP after standing more than 10 minutes and ALSO have NCS...Neurocardiogenic Syncope, another form of dysautonomia.

Both are associated with being hyperadrenergic.

You don't need to have one without the other.

Yes, hyperadrenergic 'generally' does not usually bring low BP to mind..generally high BP. A few of us on Dinet have hyper pots with low BP.

Having both hyper pots and NCS,,,Both with low BP is very unusual.

I had been DX with hyper pots, but recently a dysautonomia expert at Mayo MN dx me with both.

It is very necessary to have both an autonomic TTT to dx pots, and a cardio TTT to dx NCS, and only a catecholamine test can DX a hyperadrenergic state.

It's complicated, and can not be done with a 'one and done' test. Two different TTT tests and a standing plasma catecholamine test.

Best,

K

[gjensen]

A lot of us have overlapping presentations. Not all of us fit so neatly in a box prepared for us.

Most of us do see an increase of NE levels. Higher than what is considered normal, but it is a certain level (line that we cross) that determines whether or not we are considered hyper. I do not remember what level that is. Someone else here will know.

It would be easy to look up and find.

[Gemma]

On my test results it says normal standing is 80-520, mine was 792. In all the literature that I have read it says if its above 600 then considered hyper.

[Loulou]

My BP is all over the place...