Orthostatic Hypertension

[comfortzone]

I remember a couple of you mentioned you get orthostatic hypertension or had that result on a tilt table test .......

Can anyone share more about how your doctors treat it or if they treat it? I was increased to 50mg of Metoprolol from 25mg a week ago ~ thus far my heartrate has decreased so it's in the nineties at it's highest ~ better than the avg. hr on holter of 100.

My blood pressure though is now low/lower with rest ~ well low for me who has high blood pressure ~ 99/60 ~~~ But today with mild/light housework it's right up there again to 156/105.

So it's been about a month now on the beta blocker (plus my own 320mg of Diovan) ~ And I'm getting nervous about this cosistantly high orthostatic blood pressure. The doctor had me stop my diuretic so I don't know if that's contributory.

Cardiology wasn't taking me all that seriously it seemed as while the nurse proved it out in his office with a sitting, standing and lying B/P demonstrating my issue..........he simply said, "so you had a higher pressure today" and a few other blow off statements.

I went from 130/90 to 150/110 with sitting to 160/110 with standing...... I can reproduce this any time of the day by lying and standing....even with the beta blocker and my other b/p med.

Any advice on how to approach my primary care doctor with this? Is it unusual as a rule for dysautonomia? Mine presumably is from EDS/HM or what is aka Hypermobility Syndrome.... If I knew more than I had this and knew of a treatment program that's worked for others I could bring it up in conversation with my doctor perhaps.......

(Underlying my question is great concern about the possibility of a stroke if these high pressures continue as they are)

Thanks everyone!

[MomtoGiuliana]

I think sharing your readings at home with your dr is a good first step. Keep in mind that bp is variable even in healthy people and it is normal for bp to go up with exertion. I think you need to wait some time following exertion to measure your bp.

[comfortzone]

Yes I will do this tomorrow. It will be a full week on the higher dose of Metoprolol ~ without B/P improvement .... this does concern me ~ and a higher risk for silent stroke with those whose bodies overcompensate with sympathetic outflow where your b/p goes up with activity --- up a lot more than is usual for activity......

You would never catch these things if you didn't do a fair amount of checking and monitoring ~ thankfully I'm able to do this and am quite comfortable doing so. So we'll see what she suggests.....! Thank you so much for writing.

[firewatcher]

It might be your body's attempt to compensate for the higher dose. Or, it could be something else entirely: my new cardiologist ordered a full thyroid panel. My BP was 120/90 sitting in his office and my diastolic just won't go down if I am upright. Keep track of it and don't let them brush you aside!

[comfortzone]

Thanks firewatcher ~ I do get discouraged and almost fearful of doctors ~ even my same ones I've had for years ~ because of this odd thing.......

This morning it's more of the same ~ it looks like the morning should be your highest since you haven't had your meds in 24 hours ~ yet this thing happens any time of day ~

in bed supine 138/95 sitting on edge of bed 149/108 and finally standing 149/114

I expect she'll just turf it back into cardiology's court as she won't want to step on his toes ~ So I think I will additionally call the pediatric cardiologist mentioned here in the doctor list -- and see if he see's adults with this........It would be a 2 1/2 hour drive ~ not too bad. If he does then I'll call my cardiologist and see what he thinks about my idea of seeing a specialist in addition to him.

They will and do try to brush odd cases under the rug ~ I pray I get these pressure's under control ~ The metoprolol is definitely helping my heart rate ~ this am in bed it was only 76 -- a number I haven't seen in years and sitting 77 and standing 84.......so not bad at all ~ I love it .......... but it's again my worry of permanent problems from an issue that should be temporary.......such as a stroke...

thanks again :-)

[the4richards]

When my symptoms first started I had huge jumps in both hr and bp(bp went as high as 195/110). After about 1 1/2 months, my bp started acting more like you'd expect to see in POTS (ie, dropping very low when I stand). I don't know why, but everything started to even out after a while.

I also started out on metapropol 25 2x day, then to 50 2x day, then 50 4x day. I'm now on atenalol and less than 25 a day.

I don't know if it takes a while for our bodies to fully react to the drugs, or we are just morphing into a new phase of dysautonomia.

And I understand your stroke concerns. Both times I had to call an ambulance the EMTs said they thought I was stroking. Tests showed that my heart is very strong and normal. Just dysautonomia. Just. Sigh.

Good luck with your docs.