very high diastolic BP with standing and POTS please help

[ahmedhass]

I'm 36 y male suffering from horrible symptoms since 6 months,
I have got a POTS syndrome with heart rate jumps from 75 to 120 with standing and many other sever POTS symptoms  "dizziness, fatigue, PACs, tingling feet, shaky feeling...etc".But what makes me crazy is that spike in BP especially the diastolic. My BP in when I lay down is 125/83 but when I stand up it go fast to 140/110 this makes me mad and scored me too much.
Nowadays I am scared to do any exercise or walk a short distance because I remember that crazy spike in my BP 110 diastolic is too dangerous any I read it is indicates coronary artery disease. I went to many cardiologist they mad echo ECG come back normal.
Please help me if any one has the same problem. I don't know what to do I'm going to see another cardiologist next week he will but a 24hr BP monitor. But till that time I am hopeless.

[ahmedhass]

Thanks a lot. I'll ask the cardiologist abut this.

[is_something_wrong]

I think you should discuss this with your cardiologist next week. Clearly you must have misunderstood something. During exercise, it's not uncommon for diastolic pressure to reach very high levels. During weightlifting, for example, diastolic pressure can reach 150-250 mmHg, with a systolic pressure of 300-350 mmHg.

Your blood pressure during exercise is not supposed to be the same as during rest! During stress testing, I once had this blood pressure profile:

Baseline: 120/75 (stressed) HR 80
100 watts: 150/100 HR 110
150 watts: 160/95 HR 140
200 watts: 170/90 HR 160
250 watts: 185/85 HR 185

As you can se, initially both systolic and diastolic may increase. When you are getting warm and the blood vessels dilate, diastolic will drop while systolic continue to increase.

However, talk to your cardiologist. Hopefully you will trust him.

[ahmedhass]

I can't do exercise because my diastolic spike to 110 once I stand up. And even during short walking it is stay above 100. Which I know it is abnormal. I don't have a problem with the systolic BP it is always in normal range. But I red that the diastolic one must stay under 90 even with rigorous exercise. Mine is 80-85 at rest and 100-110 when standing up.  

[is_something_wrong]

Yes, during exercise the blood pressure will increase, in everyone. It's supposed to do so, in fact, an increase in systolic pressure below 40 mmHg during heavy exercise is abnormal.

It's not uncommon to have 200 mmHg systolic blood pressure during peak exercise and it's not dangerous.

If you are otherwise healthy, I don't understand why you can't exercise?

[ahmedhass]

thank you for your reply. Recently I don't take any medication. What you side the high noradrenaline circulation makes me think to see an endocrinologist to check the adrenal gland which I read can make the BP spike.
Really I get sever depression since I remember that exercises and walking can but me in High BP risks rather than be healthy for me.

[is_something_wrong]

I wouldn't necessarily trust that monitoring. Often diastolic pressure is measured incorrectly by automatic blood pressure monitors when you move or stand up.

Wait for the results of the 24 hour monitoring until you make any conclusions. And remember - it's the systolic pressure that is dangerous to the heart and arteries. A diastolic pressure of 110 doesn't indicate coronary artery disease, but it indicates a high amount of circulating noradrenaline.

Are you by chance taking Propranolol? At least in my case, it did increase diastolic pressure a lot during stress.