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john redman

Blood Pressure Drops More Than Pulse Goes Up!

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Dear Group,

When I lie down and then sit up, my systolic blood pressure drops as much as 39 points, and my pulse increases as much as 50 points. Is it typical of POTS for both blood pressure and pulse to change so much. Some days, the pulse does not go up by 30 or more when standing. But it is true that usually, despite the title of this thread, that the pulse goes up by more than the systolic blood pressure goes down. Thanks, John

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No. That is not typical of POTS for your BP to drop at all. POTS is classified as an increase in heart rate of greater than 20bpm upon standing without a decrease in blood pressure. A decrease in blood pressure upon standing is often called Neurally Mediated Hypotension (NMH) or Orthostatic Hypotension and is more often associated with pure autonomic failure and other such autonomic neuropathies.

I've posted links to some articles you may find helpful, you can also do a search for yourself on e-medicine to find more scholarly articles on OH. But I feel the best thing for you to do is go see a neurologist or cardiologist who can help you. Orthostatic hypotension can be indicative of something very serious, so it's really important you see someone who has experience with autonomic neuropathy who can effectively diagnose you.

Okay here're the links:

http://www.mc.vanderbilt.edu/root/vumc.php...dc&doc=4790

http://www.emedicine.com/neuro/topic609.htm

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I guess that I'm going to differ a bit with lauren/dizzydame on my answer for your question, or at least approach it from a different side of the coin.

While it is true that a drop in BP may not be "typical" for POTS and/or that it can be indicative of something else, there are MANY with "just" POTS and/or NMH/NCS who do have drops in BP (orthostatic hypotension) and most of the autonomic specialists that I've encountered don't find it particularly unusual at all. Some definitions/ info you read from different sites, journal articles, etc. may say that it's an either or situation and there are some doctors who say this is the case but most - in practice - acknowledge that for many people there is more than thing that goes on and not "just" one diagnosis.

That said, some diagnoses can go together concurrently and some are generally considered to be mutually exclusive. For example it's usually accepted that one can have POTS/OI and NMH/NCS but not POTS/OI & Autonomic Failure. For an autonomic failure diagnosis it's generally accepted that while it does necessitate a drop in BP, it also does NOT have a raise in HR. That's not all there is to the diagnosis but it's part of it.

Of course it's good idea to get thoroughly evaluated by an autonomic specialist, whether a neuro or otherwise.

Hope this helps,

:) melissa

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My son has POTS and NMH(neurally mediated hypotension). Many do. Sounds like you may, too. his is controlled really well with drug therapy. I hope yours can be, too.

All the best-

Julie

Dear Group,

When I lie down and then sit up, my systolic blood pressure drops as much as 39 points, and my pulse increases as much as 50 points. Is it typical of POTS for both blood pressure and pulse to change so much. Some days, the pulse does not go up by 30 or more when standing. But it is true that usually, despite the title of this thread, that the pulse goes up by more than the systolic blood pressure goes down. Thanks, John

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I asked Dr. Grubb this specific question and he said with POTS you will have an increase in HR on standing (+30) and you may have no BP change, or orthostatic hypotension (I have this). He said OH is common with POTS

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My original diagnosis was NCS. My BP runs 90/60 but I have seen it as low as in the 80s/40s -- and once, it dipped into the 30s (but I had already been hospitalized so others were 'monitoring' me, too). My HR never gets out of the 60s, regardless of what I am doing.

It has been the fatigue associated with all of this that gets me, as well as the unpredictablity of symptoms, etc. As time goes on, I have learned to pay attention to my body, and what goes on with me, and 'around' me, and I am more attuned to what may trigger an episode (which will cost me anywhere from 3-5 days, and has on occasion, knocked me for a loop for as long as ten days to two weeks).

It just takes time and patience, and a good, caring MD or PA to help you sort through it all, John R.

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dont get caught up with the systolic "numbers" perse but more or less how you are feeling...my professor's pressure standing is like 76/60 and she feels fine, and is considered "normal" for her..........if your pressure is dropping 39 points and you are feeling sick, then there is some cause for concern, but if you feel fine, than there's no need to worry. doc's dont diagnose hypotension unless the patient is symptomatic, not merely just by the pressure number...

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When I stand, from lying down, my BP always drops by at least 20 and my HR always goes up by at least 15. I have been diagnosed as POTS only. Not sure where this leads, but sounds like there are variations. I know my general readings, so if they change too much, then I am worried. Not sure if this helps?

!!

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