In a young adult with hypermobile Ehlers‑Danlos syndrome and suspected postural orthostatic tachycardia syndrome, is a blood pressure of 126/86 mm Hg normal or indicative of borderline hypertension?

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Blood Pressure Classification: 126/86 mm Hg is Elevated, Not Normal

A blood pressure of 126/86 mm Hg is classified as elevated/stage 1 hypertension according to current ACC/AHA guidelines, not normal. 1

Blood Pressure Classification According to ACC/AHA 2017 Guidelines

The 2017 ACC/AHA guideline redefined hypertension categories, lowering the threshold for diagnosis: 1

  • Normal BP: Systolic <120 mm Hg AND diastolic <80 mm Hg 1
  • Elevated BP: Systolic 120-129 mm Hg AND diastolic <80 mm Hg 1
  • Stage 1 Hypertension: Systolic 130-139 mm Hg OR diastolic 80-89 mm Hg 1
  • Stage 2 Hypertension: Systolic ≥140 mm Hg OR diastolic ≥90 mm Hg 1

With a systolic pressure of 126 mm Hg and diastolic of 86 mm Hg, this patient meets criteria for Stage 1 Hypertension because the diastolic pressure is in the 80-89 mm Hg range. 1

Special Considerations in Young Adults with hEDS and Suspected POTS

In the context of hypermobile Ehlers-Danlos syndrome (hEDS) and postural orthostatic tachycardia syndrome (POTS), this blood pressure reading requires careful interpretation: 2, 3

  • POTS diagnosis requires the absence of orthostatic hypotension (defined as systolic BP drop ≥20 mm Hg or diastolic BP drop ≥10 mm Hg within 3 minutes of standing), so documenting postural blood pressure changes is essential. 2, 3

  • Patients with hEDS and POTS commonly have autonomic dysfunction that can manifest as blood pressure variability, making single measurements less reliable. 4, 5

  • The ACC/AHA recommends measuring blood pressure in both supine and standing positions to detect orthostatic changes, particularly in young adults with suspected autonomic dysfunction. 1, 3

Clinical Pitfalls to Avoid

  • Do not dismiss this reading as "normal" simply because the patient is young or has POTS—the 2017 guidelines apply to all adults regardless of age. 1

  • Confirm the reading with proper technique: The patient should rest for 5 minutes before measurement, with the arm supported at heart level, using validated automated devices when possible to minimize white coat effect. 1

  • Screen for secondary causes of hypertension in young adults (≤30 years) with elevated BP, including assessment for coarctation of aorta (thigh BP measurement), renal disease, and endocrine disorders. 1

  • Recognize that patients with hEDS may have lower baseline blood pressures due to autonomic dysfunction, so even "borderline" elevations may represent a significant deviation from their baseline. 6

Recommended Next Steps

  • Obtain multiple BP measurements over several visits to confirm the diagnosis, as single readings can be misleading. 1

  • Perform orthostatic vital signs (supine after 5 minutes rest, then standing at 1 and 3 minutes) to evaluate for both orthostatic hypotension and POTS criteria. 2, 3

  • Consider ambulatory blood pressure monitoring (ABPM) if there is concern about white coat hypertension or significant BP variability, which is common in autonomic dysfunction. 1

  • Initiate basic laboratory evaluation including fasting glucose, lipid profile, serum creatinine with eGFR, electrolytes, TSH, and urinalysis to assess for target organ damage and secondary causes. 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Diagnostic Approach to Adrenal Insufficiency and POTS in Adolescent Females

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Orthostatic Hypotension Diagnosis and Clinical Significance

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

6
Research

Postural tachycardia in hypermobile Ehlers-Danlos syndrome: A distinct subtype?

Autonomic neuroscience : basic & clinical, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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