Abstract On Pots In Spring 2007 Newsletter

[ETOLY]

I was reading the Spring 2007 newsletter abstracts on the research page and came upon "The postural tachycardia syndrome.

Medow MS, Stewart JM. Cardiol Rev. 2007 Mar-Apr;15(2):67-75." In this abstract it notes:

"Adults with POTS do not have hypotension, whereas children may exhibit hypotension."

I didn't believe that this statement was correct, so I emailed Marvin Medow, one of the authors of this abstract. He wrote me back today:

"Thank you for your comment. While the statement regarding hypotension may be untrue for you, it is generally true for

the majority of POTS subjects who have been studied. As in most situations describing human physiology, there are always

exceptions to the rule."

I thought I would get the opinion of people on this site. I know you don't have to have hypotension to have POTS, but I didn't think it was that uncommon.

Etoly

[doctorguest]

Interesting response. I will have to read their entire article to comment further, but I wonder how they defined "hypotension" and how they selected their subjects. Hypotension is very common among healthy asymptomatic women, but certainly it seems even more prevalent in young adult patients with autonomic dysfunction. I share with you your skepticism about that particular statement.

[MomtoGiuliana]

I saw that and was skeptical too! I know many of us on this board suffer from hypotension-- what seems to be quite common on this board is labile bp. I would be curious too to know how they define hypotension. Do they mean low enough to cause fainting, I wonder?

I have had readings as low as 80/50--but I have never actually fainted--just felt faint. And I have episodes of slightly elevated bp.

Katherine

[Maxine]

"Adults with POTS do not have hypotension"--------------I think this is rather obtuse of a physician to make this statement. Perhaps he should say, SOME, or a PERCENTAGE of adults with POTS may not experience low blood pressure".

Maxine :0)

[Tessa]

I have read that POTS can produce a high blood pressure as well as a low blood pressure (for instance, Dr. Grubb)...

I have a very low blood pressure ALL THE TIME (my readings are 80/40)

Of course I am also completely skeptical with the research they carried out. Fore sure they did not selected the patients they should for their research...

Love,

Tessa

[Sophia3]

I often have SUPINE HyPOTENSION but RARELY if ever see this mentioned.

Then when I stand, my bp in recent years JUMPs to 125/95..I get so symptomatic with tachycardia, I lie down and in 4 minutes, BP will be normal.

I have had low BP when standing but NEVER DRASTIC DROPS.

Still, many docs address SUPINE hyPERTENSION but never low supine BP.

I know I can not be the only one but some of us do not fit neatly into any category. I have PRE syncope POTS where I never feel terrific.

But the swings iN BP can be exhausting and the tachy due to gravity issues as well.

I often wonder about many articles on POTS with ANS docs...like religion, you know. many think THEIR RESEARCH or outlook is the only one. Sigh.

[doctorguest]

Sophia,

You made me laugh with your comments - you're right, and your comment applies to all research topics in medicine, not only autonomic dysfunction. Hypertension has been studied ad nauseum because it's so prevalent and because it's a known risk factor for cardiovascular disease and stroke, and yet we still don't know its precise cause. Hypotension has been historically overlooked, if not completely dismissed, by mainstream research, so it's not surprising to see studies on supine hypertension vs. supine hypotension. My personal opinion is that when gravity exerts its effects on someone with POTS, etc., the system may overshoot with vasoconstriction and tachycardia to maintain cerebral perfusion. You still may feel pretty bad, but at least the compensatory mechanism keeps you conscious. This is just my hypothesis, so don't quote me on this .

[Sunfish]

in short, i concur...with just about all of your comments, thoughts, questions, etc.

melissa

[yogini]

All I can say is: HUH?? Hypotension seems to be listed as a symptom of POTS in most everything I've read, not to mention the countless accounts of it here on the forum. I wonder whether these doctors would agree with the use of BP-increasing drugs, such as florinef and midodrine, to treat POTS...they seem to be commonly prescribed and helpful to so many of us...

[cardiactec]

I actually have been to see dr. julian stewart, one of the guys who was part of that publication. he is very very smart and very compassionate to the pots patient.

doctorguest, last i spoke with dr.stewart, he defined "hypotension", to me anyway (not sure what is written in his paper), as a 20 point drop in systolic number that stays consistent (a 20 point drop or continued dropping) throughout a standing tilt. stewart by the way, works primarily with the pedi population, so therefore, his analysis or data of hypotension in pots patients might be more heavily weighted towards utlizing a larger pedi group in his studies than adult group.......but i dont know who and how he picks his subjects for study so i dont know about this...

[flop]

Cardiactec,

It's interesting that you have had a disscussion about hypotension with one of the authors of the paper. With you mentioning the DROP in systolic BP on tilt, it sounds like his definition of POSTURAL HYPOTENSION.

Postural hypotension is usually defined as a drop in systolic BP of 20mmHg or more within 2-3 minutes of standing. ie it is a lowering of the BP from it's baseline.

A change in BP from 180/95 to 160/90 would still be "postural hypotension" as would a change in BP from 95/50 to 70/45.

Converesly someone could be normally hypotensive at 80/40 and on standing BP changed to 85/50 (ie a normal increase in BP in standing) - that person would not have postural hypotension but does have hypotension.

Very confusing, what I am trying to illustrate is that hypotension and postural hypotension are very different things and we need to know which the authors were talking about in the paper.

NB - "postural hypotension" and "orthostatic hypotension" are often used interchangebly.

Flop

[cardiactec]

hey flop, yes, he was defining postural hypotension to me when i asked him specifically about tilt induced hypotensive response..

...was this article or is this post questioning hypotension alone without regard to orthostatic effect?? I thought the question was of POTS (positional) hypotension that was being questioned and not hypotension alone?

My doc told me that hypotension alone isnt diagnosed directly off of systolic number, but off of correlating symptoms of a "lower than normal" systolic number .......someone can have a normal baseline BP of 90/60 and not be symptomatic. my teacher's bp runs around 80 systolic and she does not have positive orthostatics (her BP doesnt drop out further with standing), and she feels fine.

[flop]

Cardiactec, the abstract doesn't mention postural hypotension, just hypotension. If anyone manages to find the full text of the article it would be interesting to see if it expands on that statement re adults with POTS not having hypotension.

Flop

[ETOLY]

Hi Everyone,

Thank you all for your responses today.

I thought I would pass along the URL for easy access to the research abstract in DINET's Spring 2007 newsletter:

http://www.dinet.org/Spring07/spr07news3.htm

I also found that the full article is available online, but you need a subscription to access it at www.cardiologyinreview.com.

Doctorguest, if you get to read the article, would be interested in hearing your thoughts.

Thanks again,

Etoly