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Postprandial Hypotension

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https://www.readbyqxmd.com/read/29658484/complexity-of-syncope-in-elderly-people-a-comprehensive-geriatric-approach
#1
C W Wong
Syncope is a prevalent health problem among elderly people. It may be neurally mediated or caused by conditions such as orthostatic hypotension, postprandial hypotension, and cardiac disorders. A combination of different aetiologies is not uncommon in the elderly people. Many pathophysiological processes, including age-related physiological changes, co-morbidities, concomitant medication use, and prolonged bedrest, coexist and predispose elderly people to syncope; advanced age and cardiac syncope are associated with increased mortality...
April 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29555655/blood-pressure-management-in-older-people-balancing-the-risks
#2
REVIEW
Jochanan E Naschitz
Guidelines of arterial hypertension treatment based on individualised expected outcomes are not available for frail older persons. In this paper, we review the evidence, concerning management of arterial blood pressure (BP) in frail older patients. We focused on the best affordable methods for BP measurement; the age-related optimum BP; specific BP goals in agreement with the patients' general heath, frailty status, orthostatic and postprandial hypotension; balancing the benefits against risks of antihypertensive treatment...
March 19, 2018: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29413718/postprandial-hypotension-in-older-survivors-of-critical-illness
#3
Thu Anh Ngoc Nguyen, Yasmine Ali Abdelhamid, Luke M Weinel, Seva Hatzinikolas, Palash Kar, Matthew J Summers, Liza K Phillips, Michael Horowitz, Karen L Jones, Adam M Deane
PURPOSE: In older people postprandial hypotension occurs frequently; and is an independent risk factor for falls, cardiovascular events, stroke and death. The primary aim of this pilot study was to estimate the frequency of postprandial hypotension and evaluate the mechanisms underlying this condition in older survivors of an Intensive Care Unit (ICU). MATERIALS AND METHODS: Thirty-five older (>65 years) survivors were studied 3 months after discharge. After an overnight fast, participants consumed a 300 mL drink containing 75 g glucose, labelled with 20 MBq 99m Tc-calcium phytate...
June 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29412439/new-simplified-screening-method-for-postprandial-hypotension-in-older-people
#4
MULTICENTER STUDY
R Abbas, A Tanguy, D Bonnet-Zamponi, R Djedid, A Lounis, M-L Gaubert-Dahan
BACKGROUND: Postprandial hypotension (PPH) is an important disorder in the older people that remain underdiagnosed. The reference PPH diagnostic method is too demanding, because blood pressure (BP) needs to be measured 8 times in 2 hours. OBJECTIVES: Our primary objective was to define a new simplified PPH diagnostic method and to evaluate its performances. DESIGN: We conducted a cross-sectional study. SETTING: Two geriatric rehabilitation units in France...
2018: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/29249295/eating-during-hemodialysis-treatment-a-consensus-statement-from-the-international-society-of-renal-nutrition-and-metabolism
#5
REVIEW
Brandon M Kistler, Debbie Benner, Jerrilynn D Burrowes, Katrina L Campbell, Denis Fouque, Giacomo Garibotto, Joel D Kopple, Csaba P Kovesdy, Connie M Rhee, Alison Steiber, Peter Stenvinkel, Pieter Ter Wee, Daniel Teta, Angela Y M Wang, Kamyar Kalantar-Zadeh
Poor nutritional status and protein-energy wasting are common among maintenance dialysis patients and associated with unfavorable outcomes. Providing foods, meal trays, snack boxes, and/or oral nutritional supplements during hemodialysis can improve nutritional status and might also reduce inflammation, enhance health-related quality of life, boost patient satisfaction, and improve survival. Potential challenges include postprandial hypotension and other hemodynamic instabilities, aspiration risk, gastrointestinal symptoms, hygiene issues, staff burden, reduced solute removal, and increased costs...
January 2018: Journal of Renal Nutrition
https://www.readbyqxmd.com/read/29058089/evidence-based-treatment-of-neurogenic-orthostatic-hypotension-and-related-symptoms
#6
REVIEW
Sabine Eschlböck, Gregor Wenning, Alessandra Fanciulli
Neurogenic orthostatic hypotension, postprandial hypotension and exercise-induced hypotension are common features of cardiovascular autonomic failure. Despite the serious impact on patient's quality of life, evidence-based guidelines for non-pharmacological and pharmacological management are lacking at present. Here, we provide a systematic review of the literature on therapeutic options for neurogenic orthostatic hypotension and related symptoms with evidence-based recommendations according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE)...
December 2017: Journal of Neural Transmission
https://www.readbyqxmd.com/read/28684639/comparative-effects-of-glucose-and-water-drinks-on-blood-pressure-and-cardiac-function-in-older-subjects-with-and-without-postprandial-hypotension
#7
Laurence G Trahair, Sharmalar Rajendran, Renuka Visvanathan, Matthew Chapman, Daniel Stadler, Michael Horowitz, Karen L Jones
Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH Eight healthy older subjects (age 71...
July 2017: Physiological Reports
https://www.readbyqxmd.com/read/28670690/possible-involvement-of-hypotension-in-postprandial-headache-a-case-series
#8
Tsubasa Takizawa, Mamoru Shibata, Takahiro Hiraide, Morinobu Seki, Shinichi Takahashi, Norihiro Suzuki
BACKGROUND: It is commonly known that headaches are induced by intake of specific food, drink, and/or additive. In addition, some patients experience postprandial headache independent of ingestion of specific items. Currently, information on the pathophysiology underlying this particular type of headache is scarce. CASE REPORTS: We report two cases in which headaches were observed after each meal. Postprandial hypotension was demonstrated in both cases. Tonometry-based continuous blood pressure measurement during head-up tilt revealed sympathetic dysfunction...
October 2017: Headache
https://www.readbyqxmd.com/read/28647892/postprandial-hypotension-in-neurological-disorders-systematic-review-and-meta-analysis
#9
REVIEW
Antun Pavelić, Magdalena Krbot Skorić, Luka Crnošija, Mario Habek
PURPOSE: Postprandial hypotension (PPH) has been associated with increased risk of syncope, falls, stroke, angina and mortality. As the majority of patients with PPH are asymptomatic, the diagnosis is often overlooked. The aim of this study was to perform a systematic review and meta-analysis of available scientific evidence on the likelihood of PPH in neurological diseases. METHODS: A systematic review of the literature (PubMed library, Cochrane Database for Systematic Reviews and Cochrane Central Register of Controlled Trials for results up to January 2017) identified 327 studies, of which 11 reported the frequency of PPH in patients with neurological diseases compared to healthy controls...
August 2017: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
https://www.readbyqxmd.com/read/28633456/feeding-during-dialysis-risks-and-uncertainties
#10
Rajiv Agarwal, Panagiotis Georgianos
Allowing dialysis patients to eat during the treatment is controversial. It is, therefore, no surprise that practices and policies with respect to intradialytic food consumption vary considerably from unit to unit and from country to country. Those who defend the position of feeding during dialysis reason that intradialytic meals offer a supervised and effective therapy for protein-energy wasting. Those who take the opposite view argue that intradialytic food intake should be avoided for the following three reasons...
June 19, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28520944/multiple-causes-of-syncope-in-the-elderly-diagnostic-outcomes-of-a-dutch-multidisciplinary-syncope-pathway
#11
Susanne C de Ruiter, Johan F H Wold, Tjeerd Germans, Jaap H Ruiter, René W M M Jansen
Aims: To assess the diagnostic outcomes of a multidisciplinary pathway for elderly syncope patients. Methods and results: Observational cohort study at a Fall and Syncope Clinic, including consecutive syncope patients aged ≥65 years between 2011 and 2014. Measurements: The sort, number, and accuracy of diagnoses resulting in syncope. Secondary outcomes: reliability of the medical history and the number of electrocardiogram (ECG) abnormalities. The 117 included patients (72% females) had a mean age of 80 ± 6...
May 1, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28331633/office-orthostatic-blood-pressure-measurements-and-ambulatory-blood-pressure-monitoring-in-the-prediction-of-autonomic-dysfunction
#12
Kawther F Alquadan, Girish Singhania, Abhilash Koratala, Abutaleb A Ejaz
BACKGROUND: In this retrospective analysis we investigated the predictive performance of orthostatic hypotension (OH) and ambulatory blood pressure monitoring (ABP) to predict autonomic dysfunction. METHODS: Statistical associations among the candidate variables were investigated and comparisons of predictive performances were performed using Receiver Operating Characteristics (ROC) curves. RESULTS: Ninety-four patients were included for analysis...
2017: Clinical Hypertension
https://www.readbyqxmd.com/read/28258090/effects-of-vildagliptin-and-metformin-on-blood-pressure-and-heart-rate-responses-to-small-intestinal-glucose-in-type-2-diabetes
#13
Tongzhi Wu, Laurence G Trahair, Tanya J Little, Michelle J Bound, Xiang Zhang, Hang Wu, Zilin Sun, Michael Horowitz, Christopher K Rayner, Karen L Jones
OBJECTIVE: To evaluate effects of vildagliptin and metformin on blood pressure (BP) and heart rate (HR) responses to intraduodenal (ID) glucose in diet-controlled type 2 diabetes. RESEARCH DESIGN AND METHODS: Study A compared vildagliptin (50 mg) and placebo, given 60 min before a 120-min ID glucose infusion at 2 or 4 kcal/min (ID2 or ID4) in 16 patients. Study B compared metformin (850 mg) and placebo, given 30 min before ID2 over 120 min in 9 patients. RESULTS: Systolic ( P = 0...
May 2017: Diabetes Care
https://www.readbyqxmd.com/read/28224105/nutrient-stimulation-of-mesenteric-blood-flow-implications-for-older-critically-ill-patients
#14
REVIEW
Thu An Nguyen, Yasmine Ali Abdelhamid, Liza K Phillips, Leeanne S Chapple, Michael Horowitz, Karen L Jones, Adam M Deane
Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons (aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28213385/effectiveness-of-acarbose-in-treating-elderly-patients-with-diabetes-with-postprandial-hypotension
#15
RANDOMIZED CONTROLLED TRIAL
Jie Zhang, Lixin Guo
: Postprandial hypotension (PPH) is a common condition that occurs primarily in elderly patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the effectiveness of acarbose for PPH; it also investigated possible mechanisms behind PPH development. This single-blind, randomized controlled trial included 91 elderly patients with T2DM, aged between 60 and 80 years, who were inpatients at Beijing Hospital between March 2012 and November 2014. The patients were included into one of three groups: Group A, patients with T2DM without PPH; Group B, patients with T2DM with PPH receiving placebo; and Group C, patients with T2DM with PPH receiving acarbose...
April 2017: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/27941058/acute-effects-of-the-glucagon-like-peptide-1-receptor-agonist-exenatide-on-blood-pressure-and-heart-rate-responses-to-intraduodenal-glucose-infusion-in-type-2-diabetes
#16
RANDOMIZED CONTROLLED TRIAL
Sony S Thazhath, Chinmay S Marathe, Tongzhi Wu, Jessica Chang, Joan Khoo, Paul Kuo, Helen L Checklin, Michelle J Bound, Rachael S Rigda, Michael Horowitz, Karen L Jones, Christopher K Rayner
AIM: To evaluate the effects of the glucagon-like peptide-1 receptor agonist, exenatide, on blood pressure and heart rate during an intraduodenal glucose infusion in type 2 diabetes. METHODS: Nine subjects with type 2 diabetes were randomised to receive intravenous exenatide or saline control in a crossover design. Glucose (3 kcal min-1 ) was infused via an intraduodenal manometry catheter for 60 min. Blood pressure, heart rate, and the frequency and amplitude of duodenal pressure waves were measured at regular intervals...
January 2017: Diabetes & Vascular Disease Research
https://www.readbyqxmd.com/read/27885251/postprandial-and-orthostatic-hypotension-treated-by-sitagliptin-in-a-patient-with-dementia-with-lewy-bodies
#17
Yoshihiro Saito, Joji Ishikawa, Kazumasa Harada
BACKGROUND Postprandial hypotension, induced by an absorption of glucose from intestine, could be treated by acarbose; however, it was unclear whether dipeptidyl peptidase-4 inhibitor reduced postprandial hypotension. CASE REPORT A 78-year-old woman who had experienced episodes of dizziness and hypotension after eating was admitted to our hospital. During 24-hour ambulatory blood pressure monitoring, there were repeated episodes of marked postprandial hypotension; i.e., a significant systolic blood pressure reduction within two hours after eating (from -58 to -64 mm Hg after meals)...
November 25, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27834292/mesenteric-vascular-dysregulation-and-intestinal-inflammation-accompanies-experimental-spinal-cord-injury
#18
Emily M Besecker, Gina M Deiter, Nicole Pironi, Timothy K Cooper, Gregory M Holmes
Cervical and high thoracic spinal cord injury (SCI) drastically impairs autonomic nervous system function. Individuals with SCI at thoracic spinal level 5 (T5) or higher often present cardiovascular disorders that include resting systemic arterial hypotension. Gastrointestinal (GI) tissues are critically dependent upon adequate blood flow and even brief periods of visceral hypoxia triggers GI dysmotility. The aim of this study was to test the hypothesis that T3-SCI induces visceral hypoperfusion, diminished postprandial vascular reflexes, and concomitant visceral inflammation...
January 1, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
https://www.readbyqxmd.com/read/27770574/risks-consequences-and-prevention-of-falls-of-older-people-in-oral-healthcare-centers
#19
REVIEW
Cees de Baat, Paul de Baat, Anneloes E Gerritsen, Karien A Flohil, Gert-Jan van der Putten, Claar D van der Maarel-Wierink
One-third of community-dwelling people older than 65 years of age fall each year, and half of them fall at least twice a year. Older care home residents are approximately three times more likely to fall when compared to community-dwelling older people. Risk indicators for falls are related to the older people's body, environment, behavior, and activities. An important health risk indicator is (orthostatic or postprandial) hypotension, which may induce cerebral hypoperfusion. Although the majority of falls remain without major consequences, 10% to 25% of falls in care homes result in bodily trauma...
March 2017: Special Care in Dentistry
https://www.readbyqxmd.com/read/27589258/recommending-small-frequent-meals-in-the-clinical-care-of-adults-a-review-of-the-evidence-and-important-considerations
#20
Hassan S Dashti, Kris M Mogensen
Small, frequent meals (SFMs) are a dietary regimen characterized by multiple small eating episodes throughout the day. Clinical nutrition guidelines recommend SFMs (eg, 6-10 meals) to patients experiencing common symptoms (eg, early satiety) and gastrointestinal-related symptoms. However, whether the provision of SFMs palliatively improves morbidity of nutritionally at-risk individuals has yet to be elucidated. This narrative review summarizes current clinical guidelines recommending SFMs for the management of diseases in adult patients (≥18 years), with supporting experimental and epidemiologic evidence, and it provides suggestions pertaining to this recommendation by drawing on potential considerations from investigations in healthy adults...
June 2017: Nutrition in Clinical Practice
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