POTS is not one condition

Neuroimmune biology, hypertensive endotypes, and why subtype should shape treatment

Disclaimer: The views expressed here are my own and do not represent my employer or any affiliated organization.

The picture most people have of POTS, if they know what POTS is at all, is tachycardia on standing, maybe a near-faint, maybe an association with low blood pressure. But that isn’t the full picture.

POTS is a form of dysautonomia: the autonomic nervous system, which controls involuntary processes like heart rate, blood pressure, digestion, and temperature regulation, isn’t working the way it should. By definition, POTS involves a heart rate increase of ≥30 bpm within 10 minutes of standing, without a significant drop in blood pressure. But that definition describes a symptom pattern and doesn’t say anything about what’s causing it.

One of the most common frustrations I hear from people with POTS is: they got diagnosed, they tried compression socks, salt, fluids and maybe a beta blockers, it didn’t work or stopped working, and then their doctor didn’t have much else to offer.

Part of the issue is that POTS gets treated like it’s one thing. It’s diagnosed based on symptoms that describe a pattern, not by what’s causing it. And in many cases, further subtype investigation doesn’t even happen. Three papers published in 2026 provide a bit more context into what POTS really is.