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Need Information About Low Pulse Pressure

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I was wondering if anyone can help me out with some information about low pulse pressure.

In the last couple of months I started feeling worse and thought that I was just going through a "flare." After paying more attention to my blood pressure readings (I had my POTS fairly well controlled and had fallen out of the habit of checking my bp regularly), I realized that my systolic reading is usually staying in the 105-115 region (sometimes spikes up) but my diastolic readings have gone up--usually in the high 80's to upper 90's.

I have been given different diagnosis over the years (Neurally Mediated Hypotension, POTS, OI, hyperadrenergic). It feels almost like my POTS is evolving over time. I don't know if this low pulse pressure thing is a new "evolution" or what. I can't figure out what it different and why it is happening....and not sure what to about it.

I have an appointment in a couple of weeks with a cardiologist. What should I know about low pulse pressure to be prepared to ask the right questions?



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Stephanie, I have a very low pulse pressure when standing or sitting up for long periods of time. Lower than the normal supine, but not anything noteworthy.

I have not looked into this seriously, and I do not want to mislead. My initial thoughts has been venous pooling, stroke volume, and some compensation of some sort. I asked my cardiologist about it, and dismissed it initially implying that it could not be because my heart was healthy. He was thinking typical causes and not from a dysautonomia perspective. He is not a dysautonomia specialist, but he is learning LOL.

My pulse pressure gets as close as 10 upright. More frequently if I am standing in one place for any length of time. 30 supine, and 20 sitting up any length of time. The closer it gets, the worse I feel. Regardless of the other numbers. I always have some drop in the systolic, more or less. Usually my diastolic raises, but not always. Sometimes they both drop in time. It varies, but the typical is as you describe.

If you come to understand it, and learn more, I would be interested in hearing what you have learned.

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Are you looking for information regarding only low pulse pressure or narrowed pulse pressure too?? Just wondering because I think I remember some past threads about narrow pulse pressure. I found this article for you.. It helped me understand and get a grasp on this topic. Gjenson, anything additional you might be able to share would be helpful as usual!


We'll help you get your list complied Steph!


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I had a link to post, but am struggling to do it. If you google pulse pressure and POTS some things will come up. Hopefully a few ideas to discuss with your doctor will come up. It is not unusual with POTS so do not get concerned with the more concerning "typical causes".

Some would say that if your PP gets as low as 10, or less, go to the emergency room. For me that is orthostatic and returns closer to normal when I return to supine.

The typical POTS treatments other than beta blockers etc. could possibly widen the pulse pressure. Beta Blockers etc. could possibly lower it for some of us by reducing output?

No, I do not think the low PP was typical for me early on. It is a change of sorts. It is certainly typical now.

Again, I attribute mine to low stroke volume due to blood pooling. My POTS appears to be rooted in peripheral denervation?

And again, I am no doctor LOL. This is only how I rationalized it for myself. I have not seen or received a solid explanation.

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Interesting. I have POTS and instead experience wide pulse pressure. My pulse pressure difference is usually around 70. For example 120/50. My diastolic at times drops even to 120/40. Surprisingly my Systolic remains very stable. Guess it means my heart works efficiently?

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My 'numbers' are ever changing. Sometimes it's tachycardia, then low bp, then high bp, and sometimes narrowed pulse pressure. When my pulse pressure got to be 16 sitting and dropped to 10 upon standing, my pots neuro tried me on midodrine. It helps most people. I unfortunately am a rapid metabolizer of certain drugs and midodrine is one of them so my body clears it before it has a chance to do it work. Interestingly, the only thing that seems to stabilize my bp and pulse pressure is prednisone and the jury is still out on why this works....as in, no one knows.

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It seems like when I start to feel like I have an understanding of this illness, something changes. I have been doing the salt and fluid thing, but when I see that that diastolic number go up (and see my blood pressure in general jump up at times) it feels like maybe salt and fluid are the wrong things to do. But, from what I have read, that is what is recommended even for hyperPOTS people with higher BP's. Just feels wrong.

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  • 5 months later...

A pulse pressure of 6 should put you down, and should be discussed with a doctor.

How are you monitoring your blood pressure?

Do not be alarmed, but do discuss it with your doctor.

I get narrow, and too narrow pulse pressures standing up. Mine has been partially managed by increasing blood volume.

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