POTS with low BP, BP rise on standing, and metoprolol

[CoolBreezes]

I know that I can't ask for medical advice here, but I'm hoping that someone has been in a similar situation and share their experiences.

I have POTS, and my doctor has prescribed 12.5mg of metoprolol daily. I have not started taking it because I am wondering whether it's a good idea to take it when my blood pressure is normally so low (under 90/60).

I did a lean test on my own, though I had to stop before 3 minutes because it caused vision issues and made me dizzy and nauseated. My heart rate rose from 82 to 140 in the first minute of standing and my blood pressure rose to 117/96. I had planned to take a reading at 3 minutes but my condition didn't allow it. (I also hope never to have to do a lean test again; it was miserable and I don't think I've recovered from it yet.)

I'm also wondering whether it will slow my heart and not allow sufficient blood flow to my brain—or does it allow the heart to fill more, so that more gets there? Is that individual? This is all so difficult.

Before doing this test I had already been increasing my fluid intake for a week or so, including electrolyte solutions.

Any experiences that might shed light on any of this for me?

(Edited to add my second concern)

 

[Rufous McKinney]

but I'm hoping that someone has been in a similar situation and share their experiences.

I hope somebody can further explain this...I am curious, too.

I take 50 milligrams for high blood pressure, but I have some version of POTS. My BP actually varies considerably.
(I don't generate those big a numbers as you do, but I had very bad POTS and tachycardia during an extended crash lasting months.).

My lean test was: after I took a shower and felt like I'd pass out, and my heart rate felt high: but was only around 110 BPM.

I need to not lean on my lean test.

 

[Shanti1]

Hi @CoolBreezes

Low-dose beta-blockers are often used as a first-line treatment for POTS, even in people with low blood pressure. They are given at a lower dose than what is typically given when treating high blood pressure with the intention of slowing the heart without dropping the BP too low, but sometimes people with low BP can't tolerate them. Yes, one of the secondary effects of blocking the tachycardia is allowing the ventricle to fill for more efficient left ventricular output.

It is theorized that non-selective beta-blockers like propranolol may be a better choice than selective beta-blockers like metoprolol. This is because a non-selective beta-blocker will also block the B2 receptors found in muscles in addition to the B1 receptors in the heart. When stimulated, the B2 receptors relax the blood vessels in the muscles to increase blood flow during "fight or flight", so blocking the B2 receptors in the muscles can help to maintain blood pressure. This is a great video to learn about the B1 and B2 receptors:
https://www.ninjanerd.org/lecture/adrenergic-receptors (first posted by @Learner1)

This video from Dysautonomia International on the Pharmacological Treatment of POTS gives a nice overview of medication options:

I haven't watched it yet by this video covers non pharmacological treatment and probably covers things like compression gear, salt and electrolights, water intake, elevating head of the bed, etc:

 

[CoolBreezes]

after I took a shower and felt like I'd pass out, and my heart rate felt high: but was only around 110 BPM.

Yeah, I realized I had POTS the first time I wore my chest strap. I took it into the shower and my HR went up to 160.

Shanti, thank you. I'll watch that video. I've found a number of lists of meds, but none that give many specifics about the differences.

My doctor is willing to work with me on this, but he's not familiar with ME/CSF so I've realized that I'll need to go in to his office with suggestions, recommendations, and (ideally) information to back that up. This is not the way I'm comfortable dealing with doctors, but I'll have to learn. (The fact that I come from a medical family probably makes this worse, since I hear them grousing about patients who come in with their minds already made up and printouts in their hands!) I'm waiting for an appointment with a doctor who, I have reason to believe, will be more knowledgeable.

 

[Learner1]

It is theorized that non-selective beta-blockers like propranolol may be a better choice than selective beta-blockers like metoprolol.

I was on propranolol for about a year but it pooped out on me and I've done well on metoprolol ever since. Worth trying different beta blockers as they're each a little different from the others. I also tried an alpha blocker which theoretically should have worked, but it spiked my pulse very high.

 

[Judee]

Sue Jackson also talks about beta blockers for POTS:

https://livewithcfs.blogspot.com/2011/03/treating-mecfs-with-beta-blockers.html

https://livewithcfs.blogspot.com/2012/11/switching-to-long-acting-beta-blockers.html

 

[Nord Wolf]

I have hyperadrenergic PoTS, so I struggle with strong levels of tachycardia as well as elevated blood pressure. When upright my heart rate skyrockets, but so does the BP. The BP does begin to lower after a few minutes, but the heart rate remains high. There is also the brain vascular piece for me. My small blood vessels in the brain don’t constrict, but rather dialate, lowering the blood pressure too much in the brain, which causes blindness.

I was on Ivabradine for 6 weeks and it kept my heart rate from going over 108, but it did nothing to control my redlining ANS. It also suppressed my metabolism badly.

This coming week my doc is starting me on Metoprolol. Hopefully that helps since it will work with BP, HTR, and the ANS.

I have used Propranolol many times before, but since it works on both the heart and lung channels it would kill my respiratory system and increase my need to use oxygen. The Metoprolol is said to mainly only work on the heart channel unless someone has severe asthma. We will see. Really hope it helps because the PoTS and the ANS have been killing my system of late. They were running so high for the last 7 days while I have just been reclined on the couch resting… that I crashed hard on Friday night into intense PEM. So infuriating.