Orthostatic Hypotension and Hypertension?

[aljanny]

Hi, all!

I'm new to this forum, and new to a dysautonomia diagnosis (still in the process of figuring out specifics, but specialist seemed pretty certain from the initial exam.) 

She asked that I record bp and heart rate sitting and then standing every morning for 2 weeks. When I sat down to type up my log in prep for an upcoming appointment, I noticed some readings that were in orthostatic hypotension range and also some readings that were in orthostatic hypertension range. (Also one reading where heart rate jumped into POTS range.) In the more normal-person range readings, they were almost evenly split between whether the bp rose or fell.  Obviously, my neurologist will likely be able to answer this when I see here, but I'm really quite curious about it. Have you heard of orthostatic hyper and hypo tension appearing in the same person? The only information I could dig up was about dysautonomia patients who have supine hypertension paired with orthostatic hypotension.

 

 

[StayAtHomeMom]

I may be your hydration levels causing the change. I watched my son's TTT week ago and his was all over the place too. Not sure 100% what causes it though. He was diagnosed with POTS. His HR was definitely elevated. Post an update what your doctor says though. I would be interested to hear. 

[Guest KiminOrlando]

I have this and they don't have a name or explanation yet. They explained it as a dysregulation of my blood pressure. 

I started with hypotension, but it has morphed in to this mess which makes it harder to treat / medicate.

I also get many, many more headaches now. Not sure if this is related. 

If you get answers, pls post.

[aljanny]

Thanks! I will be sure to update after I see my neurologist next Tuesday. I'm weirdly fascinated by this, especially since I just can't seem to find anything like it in any of my searches. Even searching 'dysregulation of blood pressure' and 'blood pressure dysregulation syndrome' didn't bring me too much, except that it seems to be something that usually presents in elderly folks who already suffer from hypertension (I'm 28 and despite my sudden drops and spikes, my blood pressure isn't either high or low at its regular level) or people with a specific glaucoma condition (pretty sure I don't have glaucoma, and the symptom list didn't match too much anyway.) I don't get the headaches you spoke of, kiminorlando, but maybe your spikes are higher than mine? Though (from my brief skim) it seems like the connection between hypertension and headaches is quite a heated debate. But wouldn't be surprised if it ended up being related somehow - dysautonomia seems to be able to mess with so many different things. 

[Pistol]

@aljanny - I suffer from BOTH hyper - and hypotension. Problem is that I feel great with a low BP ( even as low as 80/40 ) but really mind high BP ( often become symptomatic at 140/100 and pass out or have autonomic seizures anything over 156/110 ). This has been documented all over my medical record. Most of my family has hyper-POTS and we all have these fluctuating BP`s although I am the only one with seizures from high BP. I am currently well controlled with meds and IV fluids and my BP's have been regulated in the mostly 110/70 range with just occaisional spikes with activity. I have also noted that when I was not regulated my BP's would fluctuate from one minute to the other, I used to have them measured several times at the doctors office, like 4 times in one visit, and all were completely different. Today they are pretty stable.

[aljanny]

@Pistol I'm glad you were able to get that regulated! I've been seeing the term hyper-pots around the forum, but I'm not sure what it is - hyperadrenergic pots? Also, does POTS often run in families like that? 

[StayAtHomeMom]

31 minutes ago, aljanny said:

@Pistol I'm glad you were able to get that regulated! I've been seeing the term hyper-pots around the forum, but I'm not sure what it is - hyperadrenergic pots? Also, does POTS often run in families like that? 

It can. Depends on the underlying cause. My 16 year old son was just diagnosised. We have no underlying cause yet. But I am determined to find it. 

[bombsh3ll]

If I can stand long enough to get a BP reading, it tends to be high. I have POTS which is diagnosed on heart rate change rather than what happens to the BP. I also have random severe hypertensive spikes >200 which are not posture related - I have been investigated several times for a pheochromocytoma which was negative. 

When I went to get diagnosed with POTS, I had a continuous BP monitor on my finger which recorded a large drop in BP in the first 7 seconds which then corrected & would never have been caught with an arm cuff, before it shot up. 

Sometimes, you can get a drop then an overactive sympathetic response to compensate for it, which overshoots. This tends to happen if you are volume deplete (which I am) although the autonomic nervous system is a strange thing and can misbehave for many different reasons. 

Perhaps you are getting a drop followed by an overactive compensation over a slightly different timescale so are picking up both low and high readings depending how long your cuff takes to inflate or how long it takes to settle. 

Looking at a typical POTS tilt reading in a presentation by Satish Raj, the tilted BP readings were all over the place, systolic up to 200 at one spike, with generally much wider excursions from the baseline than the control patient. I found this comforting to know (although sorry for the patient!)

I tend to focus more on how I feel though than numbers - I never checked my pulse or BP before I was ill. If you are having symptoms, these are what your doctor needs to address if possible even if they are happy with your readings. 

B x

[p8d]

Welcome to the labile BP club!  I have hyperadregenic POTS and my BP generally drops when I first stand up then rises for a few minutes then starts to fall.  Not every time, it’s very erratic.  I started mostly hypo then after a few years developed hypertension.  I did have elevated norepinephrine from the beginning though.  think this:

1 hour ago, bombsh3ll said:

Sometimes, you can get a drop then an overactive sympathetic response to compensate for it, which overshoots. This tends to happen if you are volume deplete (which I am) although the autonomic nervous system is a strange thing and can misbehave for many different reasons. 

 Is what happens to me.  My problem is that I have an overactive gastropressor response so if I drink enough fluids to stop tachycardia and all the other nasty effects my BP shoots way up.  My dr and I are working on different meds to lower BP enough to allow me to drink sufficient fluids to stop this happening.  My neurologist said it’s like hitting the gas and the brakes at the same time until we find a way to better control everything.

When you do your orthostatic vitals don’t just immediately check your BP.  Lay for 10 minutes check it laying down then immediately after standing, then after 5 minutes and after 10 minutes standing still.  My BP bounces all over during this time but it’s what my neurologist does every visit.