Does the diagnosis of HyperPOTS require a rise in systolic BP and/or diastolic BP?

[Autonomic.heart]

I was diagnosed with POTS in July of 2020. My doctors didn't specify what type of POTS I have, but I suspect that I may have HyperPOTS. I have severe episodes of feeling like I'm going to pass out because of an intense feeling of "anxiety" but I never actually do. I have recently developed tachycardia when I'm laying down or sitting (well over 100bpm) and I'm not sure why. I can't tell whether I have hypertensive episodes because my BP is all over the place. I can have BP of 90/60 at one point when I stand up, but then have a BP of 180/150 at another time in the same day. I'm not sure what to look for symptom wise either that would indicate HyperPOTS. Any info would help a ton!

[Pistol]

Hello @Autonomic.heart - welcome to this forum! I am sorry to hear you are feeling so poorly. I have HPOTS for the past 12 years but I also have NCS ( neuro-cardiogenic syncope, another type of dysautonomia ). For me the biggest difference in symptoms from other types of POTS is the increase of BP upon standing, along with tachycardia. The first monitored episode of syncope ( I was wearing a monitor at the time ) showed a HR in the 120's for 3 hours before passing out, with a HR in the 180's along with a BP of 160/110. The BP was measured while I was out. I was diagnosed with TTT as well as resting and upright norepinephrine levels ( both elevated ). I too suffered from extremely labile BP. In HPOTS the BP often increases upon standing, and the lower number typically is very high ( diastolic hypertension ). A BP of 180/150, as you describe, would be dangerously high ( if it was taken correctly ). For me also the BP goes up and down constantly - when it drops too fast I pass out and when it goes up too fast I have autonomic seizures. 

The fact that you describe "anxiety" along with your spikes would lead to the suspicion of HPOTS. I always describe it more of a sensation of restlessness, excitement and impending doom rather than anxiety - I have had anxiety before but it is definitely a different feeling from what I experience from high adrenaline. Other symptoms to look for ( that are typical for HPOTS ) are cold hands and feet, tremors, yawning, chest pain and strong, fast heart beats - like your heart is jumping out of your chest. These are all symptoms of hyperadrenergic episode. 

Here is an article from our website that explains HPOTS, I hope it is helpful: