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Beala/Laura: The answer is simply high fluids intake. Many POTS patients are hypovolemic or suffer from low blood volume. In those cases, they have low plasma renin activity. Both beta blockers and florinef tend to further lower plasma renin activity and thus aren't good strategies for the hypovolemic. It's one of those cases where one person's "savior" can be another one's "poison". My daughter was taken off both beta blockers and florinef (in favor of other med strategies) because they were actually doing more harm than good. But, in short, by achieving higher blood volume through fluid intake, the heart rate actually goes down.

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Potsparent can you please tell more about plasma renin activity?

I have low blood volume and was given both a beta blocker and florinef at different times. I was put on a very high dose of florinef and told I would gain weight by retaining water and just the opposite happened to me - I lost 20 lbs and felt the worst of my life! This is the first time I have heard this. I haven't been able to figure out why florinef didn't work for me.

Should I have my kidneys checked out? or adrenal glands? Florinef was definitely a poison for me. Any more info you can give would be greatly appreciated.



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"Renin is an enzyme released by the kidney to help control the body's sodium-potassium balance, fluid volume, and blood pressure."

There was a 1997 study by Jacob/Robertson and others (with a link to it available down in the bibliography section of the dinet.org web site) that quotes "Hypovolemia occurs commonly in orthostatic intolerance. It is accompanied by an inappropriately low level of plasma renin activity. The degree of abnormality of blood volume correlates closely with the degree of abnormality in plasma renin activity. Taken together, these observations suggest that reduced plasma renin activity may be an important pathophysiologic component of the syndrome of orthostatic intolerance." They were doing the study to test the "hypothesis that reduced plasma renin activity, perhaps from defects in sympathetic innervation of the kidney, could underlie a hypovolemia, giving rise to these clinical symptoms [of POTS]".

It is said that renin activity is hard to measure even by research labs, so I'm not sure that your doctor can necessarily easily do it on some kidney test.

Anyway, with beta blockers and florinef both decreasing plasma renin activity, added by the fact that my daughter had worse problems "on" those drugs than while "off", she was discontinued off those medications. Hope this helps. Won't begin to say I fully understand all this myself, other than its bottom-line for us is to stay away from beta blockers and florinef. But then again, POTS seems to be something where different things work (or don't work) for different people.

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