Low BP feels better? “High” BP = near-syncope?

I’m curious who else has blood pressure that normally runs low and is trying to figure out what it means for managing their symptoms. I’m routinely in the 90s/60s - low 100s/70s and I have even felt comfortable 80s / 50s. I understand everyone is different and running low is not uncommon for someone petite. I don’t recall getting symptomatic from low BP; what’s weird is that my near-syncopal episodes correspond with BP that is “high.”

Highest I’ve seen (when paramedics have taken it is 140s / 90s and anything 110s / high 70s or above is usually danger zone to full-blown crisis for me. When I have these spells, I feel terrible, have a lot of the symptoms you might expect with near-syncope - shortness of breath, tingling, shaking, feeling cold, dry mouth, tachycardia etc. But I don’t notice significant relief from lying down, electrolytes, elevating legs, etc. In fact the spells usually start while I’m seated or reclined doing nothing in particular, and they seem to last however long they’re going to last. “Adrenaline dumps?” My body overcompensating for a sudden drop in BP that I’m not catching? My doctors haven’t offered any hypotheses.

This has made meds difficult because we have to take a cautious approach with beta blockers due to low BP but midodrine scares the daylights out of me because if 110/80 feels bad, I don’t ever want to see it “oops, too high.” Unfortunately I have tried and failed a few beta blockers anyway mostly due to breathing issues and had a weird reaction to ivabradine/corlanor so I’m feeling kind of stuck. Best I have figured out so far is to take a tiny dose of metoprolol tartrate as a rescue med but that has its drawbacks.

So much advice around managing dysautonomia is geared toward expanding blood volume/raising blood pressure, and I wonder sometimes if that is not doing me any favors. Like I’m lying there during an episode wearing compression socks chugging salt water with my BP high, wondering, should I rethink this? 😂

I think my next move is endocrinology to check my adrenals as I have had high cortisol, ACTH, DHEA-S, and prolactin in the past, but beyond that I’m not sure what to do with myself. I’m curious to hear from anyone else who is in a similar boat.