Hey there everyone,
I am pretty new here, but hope that its ok that I ask my weird/complicated question here. It is about my problems with low blood pressure and the medications that we (me and my neurologist) are trying. At the moment I only have fludrocortison as a standard medciation that works, I take it three times a day (62,5).
My most obvious problems at the moment are:
- Low blood pressure, we can't get it to go up most of the time
- Very narrow pulse pressure
- POTS
- Combined with bradycardia when sitting/resting.
- and often orthostatic hypotension. I got diagnosed with POTS, but that is just what happened during the tilt table test, at home I have seen my blood pressure dropping as well, so I think I appear to have both.
The diagnosis is POTS, but the doctor is still unsure, and does not say a lot about what causes my problems. So its still a search.
I take Fludrocortison, which has made my blood pressure generally a bit higher, and the pulse pressure (which was really narrow) has widened. Pulse pressure is now good, but blood pressure stays too low and I still have lots of symptoms because of that. Heart rate is still low as well.
Now here comes my question:
We tried midodrine to upp the blood pressure, which gave a really odd result. It lowered my blood pressure. The doctor did not believe that it lowered my blood pressure, but I have seen it lots of times. I measured every day. It went lower, without a doubt. Also my supine systolic pressure went down about 10 points.
Can anyone explain this? Did others experience this effect? What mechanism causes it?
My second question is:
We tried Mestinon (pyridostigmine) after that. I am still in the middle of that trail, I take 120 mg in the morning. It is supposed to make symtoms like weakness etc less, and it should make orthostatic hypotension less. But, again.. it got worse. I did a couple of standing tests at home, 1 hour after taking mestinon. My orthostatic hypotension is now more dramatic. My blood pressure lowers more quickly, and more severe. I cannot stand for 4 minutes now. The last time I measured while standing 4 minutes my bp was 67/37 (heart 72) which meant a fainting episode.
Can anyone explain this? Normally this drug makes orthostatic blood pressure better, but when I take it, it makes it worse, like with midodrine.
Mestinon also makes me dramaticly drowsy, I feel stoned (without the happy part), and sleepy, dizzy and vague. Even more then usual. It lowers my heart rate as well.
Does anyone have any thoughts about how a vasoconstricting effect, can 'lower' blood pressure. I cannot find any logic in that, and understand why the doctor did not believe it. I have seen it many times though, so I am sure that this is what it did. I was thinking that the solution to that might give insight to my real problem. The real issue that causes my blood pressure to be so weak.
Sorry for the long post. I have a hard time explaining it with less words and maybe I am a bit desperate.