Orthostatic Hypertension

So today i went to a hospital and tested blood pressure when lying, sitting and standing

It went from 120/80, to 130/90 and to 150/100

Pulse went from 60 to 150

Orthostatic hypertension

I have known i have this since the start, as i just tested it myself but forgot about it since no one cared

Now im reading about it and guess what - no one knows why the hell it happens

Cant believe my luck with these diagnoses

 

If you don’t mind me asking how come this has been tested- was it at your instigation or did a doctor ask for the tests? I think I’ve probably got this but never bothered raising it with Drs as it seems there’s nothing other than hypertension meds which I’m already taking

 

Don`t mind at all! It seemed to be standard procedure when checking for ME, or maybe they will use it for some research I dont know. Looking at the wiki apparantly doxazosin,[15] carvedilol,[16] captopril, and propranolol hydrochloride has some effect. Im suspecting this phenomena to be secondary to something though so dont know if its any point treating it. Its however nice to see why I feel so terrible when standing up, that its connected to some physical phenomena

 

Ok thanks @Marky definitely not something I’ve heard of being checked out in the U.K. I’m already on hypertension meds including an ACE so not sure anything could be done. I’m going to check out my own lying sitting and standing BP before going for my annual hypertension review and consider asking about it then if standing is high.

 

Sounds good! Its a simple test (just measurement at time intervals), so shud be possible to just ask for it!

 

Hi @NelliePledge,

If you manage to get yourself into a good NHS specialist clinic for POTS/autonomic dysfunction they will definitely be aware and note this during investigation, usually tilt table or any other orthostatic test with beat-to-beat BP monitoring. A regular cardiologist...not so likely. I think my 24hr BP average on a monitor was something like 190/100, peak 220/140 upright walking, and all my local cardiologist wanted to do was call it essential hypertension and load me up with anti-hypertensives, despite all the other obvious orthostatic symptoms and referral from GP that suspected POTS.

I ignored him and got myself into a POTS specialist clinic. They noted the hyperadrenergic tendencies and diagnosed POTS. Treatment with Ivabradine has been very helpful for symptoms and has lowered my blood pressure considerably. On paper all it is supposed to do is lower heart rate, but it actually does a lot more behind the scenes and appears to lower stress responses. From memory there are some animal tests and a small trial where it was used as a premed for surgery in humans that show this effect. Another drug talked about for this sort of thing is Clonidine, but I think that has largely been replaced by Ivabradine in POTS now.

Ryan

 

This is your classic POTS with orthostatic hypertension blood pressure response on tilt table, it was not a fun experience





I was on beta blockers at the time too! What a mess haha.

Ryan

 

exactly the same with me too, re Ivabradine.

 

Thanks I’m pretty sure I’ve not got POTS. My orthostatic intolerance kicks in after ive been standing still for a few minutes rather than immediately on standing. And if I’m moving rather than queuing I don’t get that overwhelming feeling of needing to sit down

 

Exactly the same here

 

You've actually described the classic POTS experience there.

Movement & muscle pump seems to aid venous return and keep symptoms at bay. Many people with POTS can walk around at a brisk pace for some time before coming symptomatic, a shorter time at a slower pace (shopping really gets me!), an even shorter time whilst standing still.

Fainting is not common though because the orthostatic hypertension among other things compensates, you just feel increasingly bloody awful. A tilt table test is the ultimate provocation because it isolates the muscles you'd use when standing normally and makes the effect more extreme.

You only need to have changes in heart rate and symptoms within 10 minutes of standing to meet the POTS criteria, along with no significant drop in blood pressure (though an increase is not unexpected). If you had immediate symptoms it would tend to fit Orthostatic Hypotension better than POTS.

 

The other thing that's pretty common in POTS and can have a big impact on investigation is changes with time of day.

Any good protocol should take measurements first thing in the morning, before any fluids. The tilt test I took above was in the afternoon and my heart rate only jumped 37bpm within 10 minutes (still abnormal and met POTS criteria). If it were performed in the morning it would have been double that, with a much quicker ramp.

 

Yeah, I have POTS with hypertension rather than hypotension too. I had a tilt table test done a couple of years ago when my GP thought I might have POTS but neither of us had any idea my BP was so high. It's absolutely normal when I'm lying down, but it goes so high when I've been standing, or sitting sometimes, that they had to stop the test after 3 minutes because they were worried I was going to stroke out, and my symptoms were so clear they didn't need it to be longer. My BP went from 120/70 (I was 48 at the time so that was pretty good) up to 199/140, which is a bit high! My HR went from my normal resting 55-60 to 130, both of which explained why I really don't feel well on being upright....

So I asked my GP if I could try blood pressure meds so that at least I wouldn't keel over if I had to be upright and although they don't make me feel any better, and my BP is low if I'm lying down, it's now within the "slightly elevated but unlikely to drop dead" range if I'm upright.

But seriously, I had absolutely no idea my BP was doing this as we tend to have low BP in my family so it had never occurred to me to check before. And it could actually have killed me, so it's well worth checking it yourself if you can't get a proper tilt table test done.

 

Thanks for sharing BlueSky

Is spikes dangerous though when were lying most of the time anyway? I thought it was high blood pressure over time thats something to worry about, but im no expert.

Interesting about the medication, im kinda surprised u had no side effects. Maybe ill look into it

 

I wonder if there's a progression of increasing autonomic dysregulation?

I started with orthostatic hypotension, frequent fainting and all that, but no tachycardia.

Next my BP normalised, and the fainting mostly stopped, but was replaced by postural orthostatic tachycardia.

And now my orthostatic BP is getting into hypertension territory and the tachy is still getting worse. Standing BP isn't as bad as some folk's here, only 145/100, but if my idea of progression is correct I better keep an eye on it.

Also interesting is that at my last standing test, despite high BP and tachy, I still fainted after 6 minutes, presumably due to a sudden collapse in BP (but have no actual measurements at the critical point).

 

So sorry you have this orthostatic hyPERtension, @Marky

I think that it must be even harder to treat than the delayed hyPOtension that I get (and which I think is more common). I have both NMH and POTS.

In case it's helpful, here's a link I saved a while ago with some information from Dr. David Bell (from 2000). It may not tell you anything you don't already know, and I'm not sure what parts are dated or obsolete, but I thought I'd pass it on.

http://www.oiresource.com/tresults.htm

It was also interesting to see there's a Wikipedia page about it which mentions both POTS and hypovolemia

https://en.wikipedia.org/wiki/Orthostatic_hypertension

 

I think it has to do with "hypovolemic hypertension" which David bell talked about

 

Hi everyone, I think I have this. First noticed a heavy feeling in my head when I stood up on occasion about ten years ago and a cardiologist told me had postural hypertension but that it wasn’t something they could really treat and not to worry about it. I then had a relatively symptom free period till a year ago. Since then I get this horrible flushing/ pressure feeling in my head that seems to rise up from neck when I stand up. In addition the veins in my hands become incredibly dilated to the point of being painful if I leave them down by my side. Does/ has anyone had this symptom before? By gp has me doing neck stretches as he thinks that the blood is getting trapped in my arms because of tense muscles(?).

Really struggling and most people can’t really comprehend how anything can be wrong when I seem generally well the rest of the time.

Is it the case for others that symptoms are worse towards the end of the day?

 

Yes I get the heavy feeling in my head and at times a flushing / hot feeling and pressure in my neck And head. My veins do sometimes get more visible when upright although until now I hadn’t noticed / thought about it! It may well be related to the orthostatic hypertension or tachycardia.

I would’ve thought they would need to do an MRI or another scan - send you to neurology to confirm if the blood is getting trapped in your arms?!

There are meds that can treat it. I started another thread about this a while ago - lots of people shared the meds they take for this - autonomic and postural hypertension - candesartan and Clonidine were the most commonly used ones on the thread. I also take Ivabradine for heart rate which also brings blood pressure down a little I think, but not enough. I just started Clonidine in addition to that:

https://www.s4me.info/threads/blood-pressure-medications.14369/

 

I was given Inderal (propranolol) shortly after onset on the theory that my dizziness and feelings of near fainting were caused by "panic attack syndrome" (they weren't). I think propranolol was given under the theory that it keeps the heart from racing, which was supposed to interruupt a vicious cycle that leads to "panic attack."

Propranolol didn't help me at all, but it did put my resting pulse in the 40's. I once had a pulse rate of 34 just before going to sleep. I tried taking less of it, but I continued to get these low pulse rates. I finally gave up on it when I awoke one morning with my hands feeling like blocks of ice. Once I stopped taking the propranolol, my resting pulse was about 60, which I assume was where it had been before I started taking the drug.

I mention this just as something to be aware of before you start taking propranolol, particularly if your resting pulse rate is already on the low side (like 60).


[It's kind of interesting to note that concert musicians sometimes take propranolol to combat "stage fright." I suppose it's under the same theory of an "anxiety → racing heart → anxiety" loop.]