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Postprandial Hypotension

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...
October 22, 2016: Special Care in Dentistry
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...
September 1, 2016: Nutrition in Clinical Practice
Susan O'Callaghan, Rose Anne Kenny
Neurocardiovascular instability (NCVI) refers to abnormal neural control of the cardiovascular system affecting blood pressure and heart rate behavior. Autonomic dysfunction and impaired cerebral autoregulation in aging contribute to this phenomenon characterized by hypotension and bradyarrhythmia. Ultimately, this increases the risk of falls and syncope in older people. NCVI is common in patients with neurodegenerative disorders including dementia. This review discusses the various syndromes that characterize NCVI icluding hypotension, carotid sinus hypersensitivity, postprandial hypotension and vasovagal syncope and how they may contribute to the aetiology of cognitive decline...
March 2016: Yale Journal of Biology and Medicine
Anna Solini, Ehud Grossman
Hypertension is very common in elderly subjects with type 2 diabetes. The coexistence of hypertension and diabetes can be devastating to the cardiovascular system, and in these patients, tight blood pressure (BP) control is particularly beneficial. Little information is available regarding the target BP levels in elderly hypertensive patients with type 2 diabetes, and therefore extrapolation from data in the general population should be done. However, it is difficult to extrapolate from the general population to these frail individuals, who usually have isolated systolic hypertension, comorbidities, organ damage, cardiovascular disease, and renal failure and have a high rate of orthostatic and postprandial hypotension...
August 2016: Diabetes Care
Tadashi Umehara, Atsuo Nakahara, Hiromasa Matsuno, Chizuko Toyoda, Hisayoshi Oka
Postprandial hypotension is one of the most important autonomic disorders in Parkinson's disease. However, its predictors remain unclear. We investigated which variable(s) predict the presence of postprandial hypotension in elderly patients with Parkinson's disease. The subjects were 64 patients with de novo Parkinson's disease who were 70 years or older. Postprandial hypotension was evaluated on a 75-g oral glucose tolerance test. Olfactory function, constipation, cardiac sympathetic or parasympathetic denervation, orthostatic intolerance on head-up tilt table testing, and other baseline characteristics were evaluated...
July 8, 2016: Journal of Neural Transmission
Peter Chisholm, Mahesan Anpalahan
Both hypertension and orthostatic hypotension (OH) are strongly age associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well established treatments. Not infrequently they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special references are made to patients with supine hypertension and postprandial hypotension, and older hypertensive patients...
July 8, 2016: Internal Medicine Journal
Dong In Sinn, Christopher H Gibbons
Orthostatic hypotension (OH) is defined as a sustained pathological reduction in blood pressure within 3 min after orthostatic stress such as tilt-table testing or active standing. Non-neurogenic OH is caused by either decreased cardiac output or impaired vasoconstriction without a primary autonomic disorder whereas neurogenic OH results from inadequate release of norepinephrine in the vasomotor sympathetic system. Once non-neurogenic causes of OH such as medications and cardiac problems are ruled out, neurogenic OH can be considered...
June 2016: Current Treatment Options in Neurology
Shailaja Nair, Renuka Visvanathan, Diana Piscitelli
Postprandial hypotension (PPH), a fall in systolic blood pressure (SBP) within 2 h of a meal, may detrimentally affect gait parameters and increase the falls risk in older people. We aimed to determine the effects of postprandial SBP on heart rate (HR), gait speed, and stride length, double-support time and swing time variability in older subjects with and without PPH. Twenty-nine subjects were studied on three days: glucose ("G"), water and walk ("WW"), glucose and walk ("GW"). Subjects consumed a glucose drink on "G" and "GW" and water on "WW"...
2016: Nutrients
Chinmay S Marathe, Michael Horowitz, Laurence G Trahair, Michelle Bound, Helen Checklin, Kylie Lange, Christopher K Rayner, Karen L Jones
Postprandial hypotension occurs frequently in diabetes. We show in 9 type 2 patients, that the fall in systolic blood pressure is greater in response to intraduodenal glucose infused at 4 kcal/min than 2 kcal/min, implying that strategies to slow gastric emptying may be effective in the management of postprandial hypotension.
March 2016: Diabetes Research and Clinical Practice
Masako Yamaoka Endo, Chizuko Fujihara, Akira Miura, Hideaki Kashima, Yoshiyuki Fukuba
This study investigated the combined effects of consuming a meal during postexercise hypotension (PEH) on hemodynamics. Nine healthy young male subjects performed each of three trials in random order: 1) cycling at 50% of heart rate reserve for 60 min, 2) oral ingestion of a carbohydrate liquid meal (75 g glucose), or 3) carbohydrate ingestion at 40 min after cycling exercise. Blood pressure, heart rate, cardiac output, and blood flow in the superior mesenteric (SMA), brachial, and popliteal arteries were measured continuously before and after each trial...
June 1, 2016: Journal of Applied Physiology
Jun Watanabe, Jun Maruya, Kenjyu Hara, Keiichi Nishimaki
A 79-year-old woman with a history of Parkinson's disease was admitted to our hospital because of a subarachnoid hemorrhage. She underwent clipping the next day. On postoperative days 7-9, she exhibited hypotension and disturbance of consciousness after each meal. The administration of midodrine relieved the hypotension, and postprandial coma was no longer observed. In this case, the autonomic dysfunction in Parkinson's disease and impairment of cerebral autoregulation during cerebral vasospasm may have been involved in the postprandial hypotension (PPH) and coma...
April 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Ahmet Yalcin, Volkan Atmis, Ozlem Karaarslan Cengiz, Esat Cinar, Sevgi Aras, Murat Varli, Teslime Atli
In Parkinson's disease (PD), non-motor symptoms may occur such as autonomic dysfunction. We aimed to evaluate both parasympathetic and sympathetic cardiovascular autonomic dysfunction in older PD cases. 84 PD cases and 58 controls, for a total of 142, participated in the study. Parasympathetic tests were performed using electrocardiography. Sympathetic tests were assessed by blood pressure measurement and 24-hour ambulatory blood pressure measurement. The prevalence of orthostatic hypotension in PD patients was 40...
January 2016: Aging and Disease
Xiao Zou, Jian Cao, Jian-Hua Li, Yi-Xin Hu, Yu-Song Guo, Quan-Jin Si, Li Fan
OBJECTIVE: To assess the prevalence of and risk factors for postprandial hypotension (PPH) among old and very old Chinese men. METHODS: The study included 349 Chinese men aged 65 and older, grouped into two age categories: group 1 (old) included 163 men aged 65 to 80 years; group 2 (very old) included 186 men aged over 80 years. Blood pressure changes after meals were assessed every 15 min by ambulatory blood pressure monitoring. Symptoms after meal ingestion and after standing up and changes in the baseline condition relative to blood pressure changes were observed continuously...
November 2015: Journal of Geriatric Cardiology: JGC
A J Scheen
Empagliflozin is a new inhibitor of sodiumglucose cotransporters type 2 (SGLT2) for the treatment of type 2 diabetes mellitus (T2DM). Its specific action inhibits glucose reabsorption in renal tubules and thus promotes glucosuria. This effect results in a reduction in fasting and postprandial glycaemia and a decrease of glycated haemoglobin (HbA(Ic)), independently of insulin. Furthermore, calorie urinary loss promotes weight reduction and osmotic diuresis lowers arterial blood pressure. The efficacy of empagliflozin increases according to the level of hyperglycaemia but decreases in patients with renal insufficiency...
September 2015: Revue Médicale de Liège
Stijn Soenen, Christopher K Rayner, Karen L Jones, Michael Horowitz
PURPOSE OF REVIEW: This article reviews the impact of ageing on the gastrointestinal tract, including effects on the absorption of nutrients and drugs and the gastrointestinal tract defence system against ingested pathogens. RECENT FINDINGS: Recent publications support earlier observations of an age-related selective decline in gut function including changes in taste, oesophageal sphincter motility, gastric emptying, and neurons of the myenteric plexus related to gut transit which may impact the nutritional status...
January 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Wei Qiao, Jing Li, Ying Li, Duan Qian, Lei Chen, Xiansen Wei, Jiangli Jin, Yong Wang
OBJECTIVES: Postprandial hypotension (PPH) is a unique clinical phenomenon in the elderly, but its underlying pathogenesis has not been completely elucidated, and drug treatment is still in clinical exploratory stage. The aim of the study was to evaluate the relationship between the fall in postprandial blood pressure and splanchnic blood flow, and to provide a theoretical basis for the treatment of PPH by taking acarbose. PATIENTS AND METHODS: The study included 20 elderly inpatients diagnosed with PPH concomitant with abnormal glucose metabolism at stable condition...
February 2016: Blood Pressure Monitoring
Sofie Jansen, Jaspreet Bhangu, Sophia de Rooij, Joost Daams, Rose Anne Kenny, Nathalie van der Velde
OBJECTIVE: Cardiovascular disorders are recognized as risk factors for falls in older adults. The aim of this systematic review was to identify cardiovascular disorders that are associated with falls, thus providing angles for optimization of fall-preventive care. DESIGN: Systematic review. DATA SOURCES: Medline and Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: studies addressing persons aged 50 years and older that described cardiovascular risk factors for falls...
March 1, 2016: Journal of the American Medical Directors Association
Deborah Ariza, Fernanda Novi Cortegoso Lopes, Carlos Cesar Crestani, Marli Cardoso Martins-Pinge
Parkinson's disease (PD) is mainly characterized by motor signals. However, non-motor signals also affect and decrease the quality of life of PD patients. Among these non-motor signs are cardiovascular disorders as orthostatic hypotension, postprandial hypotension and cardiac arrhythmias, which may be due to the involvement of both central nervous system and peripheral autonomic nervous system. In the present study we investigated the cardiovascular function, evaluating cardiovascular reflexes (chemoreflex and baroreflex), in an animal model of Parkinsonism induced by bilateral infusion of the toxin 6-hydroxydopamine (6-OHDA), in the substantia nigra pars compacta (SNpc)...
October 21, 2015: Neuroscience Letters
W Liang, L Gao, N Li, B Wang, L Wang, Y Wang, H Yang, L You, J Hou, S Chen, H Zhu, Y Jiang, H Pan
Bromocriptine-QR (quick release) is a novel treatment for type 2 diabetes. The objective of this study is to assess the efficacy and safety of bromocriptine-QR in adults with type 2 diabetes mellitus based on randomized controlled trials published in peer-reviewed journals or as abstracts. We performed a comprehensive literature search of MEDLINE, Pubmed, Web of Science, EMBASE, and the Cochrane Library up to May 2015. Randomized controlled trials of bromocriptine-QR therapy in type 2 diabetes mellitus were eligible...
October 2015: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
José Alfie
Postprandial hypotension, defined as a fall in systolic blood pressure (SBP) of 20 mmHg or greater within 2 hours after a meal, is a risk factor for stroke, coronary events and mortality. The clinical suspicion is typically raised by episodes of postprandial syncope or falls, whereas asymptomatic postprandial hypotension is mostly neglected. The magnitude of the postprandial fall in SBP, as detected by 24-hour recording in apparently healthy middle-aged to elderly subjects, was proportional to the severity of the silent cerebrovascular damage...
August 2015: Therapeutic Advances in Cardiovascular Disease
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