POTS with hypertension

[Phanchaztik]

Let me start by saying, I am in no way trying to belittle anyone’s symptoms, I just can’t relate to most pots symptoms or complaints. OK… I have hyperadrenergic POTS with Orthostatic Hypertension. Now I have read blog after blog and video after video of people saying they have this and their bp readings are like 138/98. Hypertensive, yes… But my bp laying is 80/60 with pulse of 52. Sitting 130/98 p 116, standing 210/160 p180. I feel for those who feel they are hypertensive… But I am like heart attack numbers and can’t get a doc to do more than medicate me to the point of sedation and send me to a hospital,Who gives me an iv and has me lay down so my numbers look good and send me home. I get told to return if my numbers are above 160/110. Well that’s every day at this point. I do get that severe intercranial pressure, clear drainage from my nose. Chest pain, dizziness, numbness. Anyone relate? Help! Please.

[Dr. Diana]

I just wanted to mention that I’ve seen some patients with a diagnosis of Hyperadrenergic POTS whose catecholamines have NOT been elevated when standing. I don’t believe these folks are diagnosed properly in many cases. We must consider catecholamines first — if not elevated, what could the cause of high BP be? Fibromuscular dysplasia is a possibility I would consider to start with.

[Barbara]

Just wondering, could you possibly have cranio-cervical instability ?

I’m just considering the mechanics because, I have increasing hypertension when I stand up and the drawing below (sorry it’s very basic!) depicts what happens to the head quite often when people are standing. You are no longer looking straight ahead most of the time and will often be looking down, with your head in ‘flexion’ quite a lot of the time – this in itself, if you do have cranio-cervical instability, can cause a restriction at the cranio-cervical junction, of the cerebro spinal fluid flow.

The way this restriction happens, if you do have cranio-cervical instability, is this:-
The weight of your head (which is very heavy) is affected by gravity and slides, ever so slightly forwards, this closes the gap between the opisthion (back of the opening through the skull) and the back of the dens (uppermost peg-bone of neck) in a pincer-like movement, putting compression on the structures that pass through the skull opening, i.e. brainstem, blood vessels etc.

http://prettyill.com/forums/viewthread/712/P45/#4612

This in itself would cause both high blood pressure and tachycardia, as mechanisms to try to keep the brain oxygenated.

Adding to that, if you’re unfortunate enough to have such additional anatomical differences as a short clivus, or a retroflexed odontoid, this can further add to the compression, when your head is in flexion.

http://prettyill.com/forums/viewthread/712/P15/#4079

Try and do as much as you can in a seated position and when you are upright, try and keep your head ‘squarely’ over your shoulders, to see if this improves things.

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