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Hypertension after showering.


Scout

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I just had a shower and noticed my head pounding a lot more than usual.

When I got out, I checked my BP and it was 127/115. 

It dropped dramatically as soon as I laid down on my bed. 

I've always had POTS episodes in the shower, heart racing, dizziness etc, but lately they are getting a lot worse.  Yesterday my reading was 118/102 after a shower. 

I will try and have a luke warm bath tomorrow instead of a hot shower, and then take a BP reading to compare. 

Just wondered if many others have experienced such a severe spike in BP due to the hot water and steam? Does anyone understand the mechanism of this? Is it because the heat / steam dilates blood vessels? 

I'm seeing my specialist very soon and starting new medication so hoping that will also assist. Those spikes terrify me. 

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@Scout - yep, I know all about this. In my case the BP either drops as a reaction to vasodilation caused by the hot water and if I don't lie down I pass out or the vasodilation triggers the sympathetic nervous system to kick in, norepinephrine gets dumped, vasodilation turns into extreme vasoconstriction and the BP goes up, HR goes up, fight-or-flight comes on and if I don't lie down I take an autonomic seizure. What @Outaker says is right - peripheral resistance causes the increase in diastolic pressure. Here is a brief explanation I found online:

Peripheral Resistance

Peripheral resistance is the resistance of the arteries to blood flow. As the arteries constrict, the resistance increases and as they dilate, resistance decreases.

Peripheral resistance is determined by three factors:

  1. Autonomic activity: sympathetic activity constricts peripheral arteries.
  2. Pharmacologic agents: vasoconstrictor drugs increase resistance while vasodilator drugs decrease it.
  3. Blood viscosity: increased viscosity increases resistance
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7 minutes ago, Pistol said:

@Scout - yep, I know all about this. In my case the BP either drops as a reaction to vasodilation caused by the hot water and if I don't lie down I pass out or the vasodilation triggers the sympathetic nervous system to kick in, norepinephrine gets dumped, vasodilation turns into extreme vasoconstriction and the BP goes up, HR goes up, fight-or-flight comes on and if I don't lie down I take an autonomic seizure. What @Outaker says is right - peripheral resistance causes the increase in diastolic pressure. Here is a brief explanation I found online:

Peripheral Resistance

Peripheral resistance is the resistance of the arteries to blood flow. As the arteries constrict, the resistance increases and as they dilate, resistance decreases.

Peripheral resistance is determined by three factors:

  1. Autonomic activity: sympathetic activity constricts peripheral arteries.
  2. Pharmacologic agents: vasoconstrictor drugs increase resistance while vasodilator drugs decrease it.
  3. Blood viscosity: increased viscosity increases resistance

Thanks so much for the info.

@Pistol Do you find sitting down in the shower helps with this? 

Any other tips which have helped? 

Really appreciate everyone's feedback. 

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@Scout - I used to have to take lukewarm showers sitting on the floor of the shower with my husband helping me so I did not pass out. I am much improved since then ( thanks to weekly IV fluids ) and now take showers sitting down, lukewarm, making them as short as possible and use shampoo/conditioner combo so I only have to wash my hair once. Afterwards I rest in bed until I feel better, in my house when Mom takes a shower it is equal to running a marathon or climbing mount Everest, everyone stays out of my way afterwards until I give them the OK!!! Some people use shower chairs but I prefer sitting on the floor or even taking lukewarm baths - I can still fall out of a chair!!! ( Speaking from experience ). 😒 My best advice is to treat a shower as a high point of your day, lukewarm water and rest afterwards. Be well!!!!!!

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Blood viscosity: increased viscosity increases resistance

I just realized that this is why I am so much improved by IV fluids - they decrease the blood viscosity and therefore decrease resistance!!!!! That's why my BP is normal and the POTS symptoms greatly improved on IV fluids! Duh!!!!🧐

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@Pistolawesome explanation of peripheral resistance, thanks.  I haven’t taken anything other than short lukewarm showers since I was diagnosed.  I too use a 2 in 1 shampoo and conditioner.  I only shower every 3rd day after aerobic exercise and for several years had to lay down afterwards for awhile.  When I was really bad I showered every 5 to 7 days at night with my husband’s help and went to bed immediately afterwards.  My husband now just stays in the house when I shower in case I fall or need help.

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I'm so confused and angry. 

I have been having lukewarm showers sitting down and my BP is still going up.

I just don't get it.

It comes down as soon as I lay down on my bed. 

It feels like no matter what I do, things just go wrong. 

Sorry — I'm feeling very frustrated today. 

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4 minutes ago, Scout said:

I'm so confused and angry. 

I have been having lukewarm showers sitting down and my BP is still going up.

I just don't get it.

It comes down as soon as I lay down on my bed. 

It feels like no matter what I do, things just go wrong. 

Sorry — I'm feeling very frustrated today. 

I'm frustrated and depressed daily on top of being tortured. You aren't alone. I'm only 31. My wife and I can't even go on a honeymoon anymore. Unless something changes. I feel like utter trash today just from going to the Dr. Extra utter trash. But yeah, you aren't alone.

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I'm so sorry you're in the same boat @Derek1987

I'm 31 as well. 

We are far too young to be having this happen and it's just so unfair.  It's not fair no matter the age, of course, but I think perhaps harder to deal with when we have people saying "shouldn't you be fit and healthy?" 

I wish I could figure out what the h*** my body is doing, but for now, I guess it is what it is. 

I thought for sure that laying down and not having the water hot in the shower would help, but it barely changed things. My BP is still shooting up — just not quite as high. I wonder if lifting my arms at all is causing it to go up. 

Anyway. I hope you have an OK day Derek. 

How high does your BP go? 

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3 minutes ago, Scout said:

I'm so sorry you're in the same boat @Derek1987

I'm 31 as well. 

We are far too young to be having this happen and it's just so unfair.  It's not fair no matter the age, of course, but I think perhaps harder to deal with when we have people saying "shouldn't you be fit and healthy?" 

I wish I could figure out what the h*** my body is doing, but for now, I guess it is what it is. 

I thought for sure that laying down and not having the water hot in the shower would help, but it barely changed things. My BP is still shooting up — just not quite as high. I wonder if lifting my arms at all is causing it to go up. 

Anyway. I hope you have an OK day Derek. 

How high does your BP go? 

I've had a reading at the doc's office 180/120. It's not usually that high but it always goes up when I do anything at all. If I do a chore 10 mins or longer, it's not unusual to see 150s over 100 plus.

My lower number is always in good range when I'm laying down. My upper number is still high for some reason. A little lower laying down than being upright but still high. Then again sometimes both numbers go too low laying down. Because of meds. Sometimes I'll have to take midodrine to boost my pressure. It's a hassle checking bp all day.

I went to the doctors today. I am so freaking tired. Not to mention tortured with adrenaline as I sat there. Looking like some type of addict. I had to go lay back in the car at one point. This disease is terrible. I want to do outdoor adventurous things. I love the outdoors. Can't do anything now. I go nowhere but to the doctor. 

Hit me up if you are feeling down. We can bond in our misery lol. Maybe it'll get better someday.

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4 hours ago, Scout said:

Thanks so much @Derek1987. Indeed — at least we can all be here for each other through this! 

Your BP issues sound so similar to mine. It can be very episodic, but it's just... so odd. 

I hope that you're right and one day it gets better. We have to have hope, right?

 

Yes yes. How did your illness start? Did it come on suddenly or gradually over time you had issues popping up?

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Dear @Scout and @Derek1987 --- I am sorry you are both having such difficulties. I understand - I was there too. Good news: it CAN get better, it has for me!!! The trick is - you have to have a specialist and if one med does not work you have to try another. I was highly unstable for 9 years and my specialist tried many different med combos until we hit the jackpot. ----- Both of you seem to not be very well controlled on your medications - here is a list of meds that are recommended in the treatment of hyperadrenergic POTS ( from the article " Hyperadrenergic POTS - a simple overview" ) on this web site.  Quote

Some of the medications that have been found helpful are:

  • Adderall, Ritalin
  • Florinef
  • Clonidine
  • Beta-blockers (especially the combination of Carvelidol and Labetaiol)
  • Midodrine
  • SSRI/SNRI
  • Modafinil
  • Methyldopa

One of the more significant findings in the treatment of hyperPOTS is the general observation that centrally acting sympatholytics (Clonidine, Methyldopa & others) and beta-blockers seem to work better to manage symptoms in people with hyperPOTS than patients with neuropathic POTS. (Grubb, et.al)      End Quote

Personally I would like to also add Diltiazem,  a calcium channel blocker that has helped me a lot.

---  You are really breaking my heart because I know what it feels like to be this beaten down!!! What I have learned is not to ever settle and think that this is the end of the road. I used to be such a pest with my doctors b/c I just could not get better but was not having any part of it!!! So they kept trying meds until something worked. It took years and a lot of ups and downs - but that still beats JUST downs!!! Keep at the docs, make sure you see an autonomic specialist ( if you don't already do so ) and try whatever meds they recommend, even it means you have to be brave. Don't give up, don't settle and NEVER stop trying!!!!!!!!

 

 

 

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Just wanted to sympathize and say that I too get BP raise with narrowing pulse pressure on standing. 

I have not had a shower in 5 years (I have baths now), and not too hot. 

That pattern is typical of low blood volume and low stroke volume. The sympathetic nervous system is raising the BP to try and compensate for this. 

As yet I have not found a helpful treatment. I have been trying IV saline but just pee it all straight out again as I am mineralocorticoid deficient. 

Sorry you guys are going through this too. 

Hugs,

B xxx

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@Pistol — Thank you so much for the kind words. Honestly, it really helps to know it gets better. It's so easy to feel like this is it... like it won't get better, but thank you for reminding me that there are still options, and that things will improve. It's just about finding the right balance and combination of meds. 

My autonomic specialist is away for July and August, so I am seeing her in September when she's back. I'm so hopeful for some progress. Also seeing my cardiologist in a month. 

@bombsh3ll Thanks so much also for your input and your kindness. I'm so sorry that we are all going through this. It makes total sense what you say about the low blood volume / low stroke volume, and how the sympathetic nervous system is therefore working on overdrive. Frustrating having bodies that do this, but hopefully we can adapt as well as possible. Thanks again. 

@Derek1987 My illness started around 10 years ago. I had a bad episode with my heart condition, and then, all of a sudden, was having POTS symptoms (I didn't know it was POTS back then). I think possibly my heart issues triggered my ANS to malfunction, or visa versa. My specialist said a lot of people — especially females — seem to have mitral valve prolapse (what I have), and dysautonomia. They think those things are likely linked. How about you? When did this all start happening? 

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On 6/25/2019 at 8:20 PM, Scout said:

@Pistol — Thank you so much for the kind words. Honestly, it really helps to know it gets better. It's so easy to feel like this is it... like it won't get better, but thank you for reminding me that there are still options, and that things will improve. It's just about finding the right balance and combination of meds. 

My autonomic specialist is away for July and August, so I am seeing her in September when she's back. I'm so hopeful for some progress. Also seeing my cardiologist in a month. 

@bombsh3ll Thanks so much also for your input and your kindness. I'm so sorry that we are all going through this. It makes total sense what you say about the low blood volume / low stroke volume, and how the sympathetic nervous system is therefore working on overdrive. Frustrating having bodies that do this, but hopefully we can adapt as well as possible. Thanks again. 

@Derek1987 My illness started around 10 years ago. I had a bad episode with my heart condition, and then, all of a sudden, was having POTS symptoms (I didn't know it was POTS back then). I think possibly my heart issues triggered my ANS to malfunction, or visa versa. My specialist said a lot of people — especially females — seem to have mitral valve prolapse (what I have), and dysautonomia. They think those things are likely linked. How about you? When did this all start happening? 

I think I've had it all my life in my opinion. My dad takes meds to slow his heart down. His hands have shaken all of his life. So have mine. People always would point it out to me. I've always had anxiety since I can remember.

 

I started having heart palpitations in my early 20s. I started being extremely fatigued as well. I just wanted to sleep after work because I was so tired. I guess I just ignored it and kept moving.

I got married in 2016. Which obviously I had less time to even sleep. I was so tired all the time and my wife would complain in rage because I never wanted to do anything but rest when I could. 

Fast fwd oct 2017, I was at Olive garden. I finished my meal and got really light headed. I got super hot. Lost my vision, my hearing, and the ability to move. Obviously I was taken to the hospital. I thought I was dying. The doctor said it's nothing to worry about.

Fast fwd to Sept 2018 my wife was arguing with me about something. I was exhausted. And my body tried to faint out of nowhere. No warning signs. Went to the hospital. Found nothing wrong of course. It was a 3 day weekend so I rested. I went to work Tuesday and made it fine. Still exhausted. Wednesday after 4 hours on the clock, I was walking and felt like a shock punch to my stomach and my legs gave away. My body again was trying to faint. 

 

That's the last day I worked. After many doctor appointments and referrals, I'm just now being diagnosed with hyperpots. 

 

I have horrible anxiety most of the day. I went to the doctor a couple days ago. I was out of the house for like 5 hours. The adrenaline from the heat and being around people and sounds was killing me. When I got home, I couldn't keep my eyes open. Went to sleep. Woke up. Slept some more. 

I went to my autonomic specialist today and did another test where they put these electrodes on your body then you have to hold your breath and stuff. I couldn't believe how bad I felt. My hands and arms turned super red. My forehead got a bit moist. Just from breathing a certain way. 

I pretty much suffer 90 percent of the day. I can't and don't go anywhere but to the doctor. Anyways I think I've always had it, and it was passed down. The older I got, the more my body couldn't handle it I guess.

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