Recommended reading on pulse pressure?

Question

Hello all. I'm trying to get diagnosed with what I suspect is a dysautonomic issue related to orthostatic intolerance. It isn't POTS so my doctor has decided it's nothing. So I am trying to gather evidence to self advocate. I shouldn't be this tired and dizzy.

I've been doing active stand tests with a blood pressure monitor. Basically resting and then readings at 0, 1, 5, 10m. One time I leaned on the wall and it was worse. My hands and legs go splotchy and purple. I am pale skinned but this is much worse than the normal mottling. Sometimes I feel dizzy and have physical anxiety. My legs and feet hurt but I assume that's because standing still is hard on your legs.

I almost passed out on one of the mornings, but only that one time. I can be tachycardic (147) but only briefly. It comes back down to 117 or so or sometimes right back down to my resting rate or doesn't raise at all. Never a sustained or increasing 30bp spike. So not POTS.

However my blood pressure does funky things. I go from 94/63 to 140/75 sometimes but not always. Sometimes it stays up in the 120 range and sometimes it comes back down slowly. But on most days, my pulse pressure narrows from a healthy mid 30s (30-50% of systolic) to 12-16 (sometimes as low as 12.5% of systolic) within ten minutes. One time my diastolic randomly went over 90 while my systolic stayed the same. I flipped through my notes and the dizziness and faintness correspond well with that. The time I nearly passed out the cuff couldn't get a reading. It reinflated and I sat down because I was getting tunnel vision. I suspect what happened was the pulse pressure was lower than the minimum.

In other words my resting blood pressure is low end of healthy, very normal, and when I stand it goes all sorts of whacky and stays that way. I'm aware blood pressure should change a little on standing but this seems extreme. My body does not like being stood up.

I have a 48hr holter soon but I'm certain my heart isn't the problem. So I want to come with information so I'm not just brushed off again. I eat a good diet and take regular brisk walks so I'm not out of shape. The symptoms are only bad if I stay still. I think moving around helps the blood flow.

I can't take more readings for a while as I noticed the cuff was leaving streaks of little pinpoint bruises. Oops.

Does anyone know of any books or papers I can use to point my doctor to or print out?

Posted May 28, 2026, 10:53 AM UTC

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