Understanding Hyperadrenergic POTS

Living with POTS (Postural Orthostatic Tachycardia Syndrome) can be challenging, and for some, a specific subtype called Hyperadrenergic POTS makes things even more complex. If you’ve noticed symptoms like shakiness, anxiety, high blood pressure when standing, or a racing heart, you may be dealing with more than just typical POTS. Let’s dive into what Hyperadrenergic POTS is, how it’s diagnosed, and how you can manage it.

What Is Hyperadrenergic POTS?

Hyperadrenergic POTS is a subtype of POTS where the sympathetic nervous system is overactive, leading to an excess of norepinephrine—a stress hormone. This means your body is constantly in “fight or flight” mode, especially when you’re upright.

Common symptoms include:

• A heart rate increase of 30+ bpm (or over 120 bpm) within 10 minutes of standing

• Anxiety or panic attacks

• Tremors or shakiness

• Elevated blood pressure when upright (systolic > 140 mmHg)

• Nausea

• Sweating

• Chest pain or shortness of breath

• Headaches, especially upon standing

How Is It Diagnosed?

Diagnosis often begins with a tilt table test to measure heart rate and blood pressure response when moving from lying down to standing.

To confirm the hyperadrenergic subtype, a blood test measuring norepinephrine levels is done—usually while the patient is upright. A level above 600 pg/mL is often used as the cutoff for diagnosis.

Additional tests may include:

• 24-hour urine catecholamines

• Plasma metanephrines (to rule out pheochromocytoma)

• Autonomic nervous system testing

How to Manage Hyperadrenergic POTS

Management typically requires a combination of lifestyle changes, medications, and dietary adjustments.

1. Medication Options

• Beta-blockers: Reduce heart rate and help blunt the effects of adrenaline

• Clonidine or Methyldopa: Suppress sympathetic nervous system overactivity

• Pyridostigmine: Enhances parasympathetic (rest and digest) activity

Always work with a healthcare provider to find the right medication plan for you.

2. Lifestyle and Non-Medication Strategies

• Compression garments: Help blood flow return to the heart

• Elevating the head of the bed: Minimizes fluid shifts overnight

• Regular recumbent exercise: Builds tolerance and supports circulation

• Stress reduction techniques: Yoga, deep breathing, meditation

3. Hydration & Salt Intake

Increasing fluid and sodium intake is essential to maintaining blood volume. However, plain water or salt alone often isn’t enough.

That’s where Oral Rehydration Salts (ORS) like NormaLyte come in. NormaLyte is pharmacist-developed and clinically proven to help manage POTS symptoms by promoting optimal fluid absorption.

• Contains WHO-recommended electrolyte ratios

• PURE formula contains no artificial sweeteners

• Easy to use daily and travel-friendly

Resources for More Information

• Dysautonomia International

• NIH: Postural Tachycardia Syndrome

• Cleveland Clinic: POTS Overview

Final Thoughts

Hyperadrenergic POTS adds a unique layer of complexity to dysautonomia, but with the right tools and support, it’s manageable. Understanding your symptoms, getting a proper diagnosis, and using targeted strategies like ORS, medication, and stress reduction can make a big difference in daily life.

If you're struggling with hydration and symptom flare-ups, consider trying NormaLyte as part of your routine. It could be the missing piece you’ve been looking for.

Disclaimer: This blog is for informational purposes only and should not replace professional medical advice. Always consult a healthcare provider for diagnosis and treatment.