Prevalence of postprandial hypotension in older adults: a systematic review and meta-analysis

Effects of Metformin on Postprandial Blood Pressure, Heart Rate, Gastric Emptying, GLP-1, and Prevalence of Postprandial Hypotension in Type 2 Diabetes: A Double-Blind Placebo-Controlled Crossover Study

ARTICLE HIGHLIGHTS

Postprandial hypotension (PPH) occurs frequently in type 2 diabetes. Metformin has cardiovascular effects independent of its glucose-lowering capacity, which may modulate the risk of PPH. We investigated the effects of metformin on postprandial blood pressure, including PPH events, heart rate, glucose, insulin, glucagon-like peptide 1 (GLP-1), and gastric emptying, in individuals with type 2 diabetes. Metformin attenuated postprandial decrease in blood pressure and reduced PPH events, in association with augmentation of plasma GLP-1, slowed gastric emptying, and increased heart rate, in type 2 diabetes. These findings establish novel cardiovascular effects of metformin that may mitigate the risk of PPH in type 2 diabetes.

Distinct Effects of Wheat and Black Bean Consumption on Postprandial Vascular Responses in People with Arterial Stiffness: A Pilot Randomized Cross-Over Study

Background/Objective: Postprandial vascular responses impact vascular health. This study investigated whether eating pulses or whole grains can acutely relax blood vessels in people with arterial stiffness. Methods: A single-blinded, controlled randomized cross-over clinical trial was conducted to compare the effects of pulses (¾ cup black beans) versus whole grains (¾ cup whole wheat kernels, also known as wheat berries) versus white rice (¾ cup) on postprandial vascular responses in males and females with established arterial stiffness (n = 9, 3M/6F, 50-64 years old). Peripheral and central hemodynamic measurements were obtained non-invasively prior to and 2 h after food consumption and were compared by t-test within a food type. Results: Peripheral and central systolic blood pressure was increased (4%) after eating white rice but not after the consumption of wheat or beans. A marked decline in augmentation index at 75 bpm (arterial stiffness) from 26.1 ± 3.6% to 16.2 ± 2.0% was observed 2 h after eating whole wheat but not beans or white rice. All foods slightly decreased heart rate at 2 h but had limited effects on other parameters of circulatory or heart health. Conclusions: Eating whole wheat or beans acutely improved overall vascular and heart health when compared to white rice. The effects of wheat and beans were distinct, with whole wheat having a major positive effect on blood vessel stiffness. The findings suggest that regular inclusion of both whole wheat and beans in the diet would be beneficial for improving cardiovascular health in persons exhibiting signs of arterial dysfunction, thus providing a potential therapeutic benefit for individuals who are at risk of heart attack and stroke. The study was registered (NCT05818358) on ClinicalTrials.gov.

Postprandial Hypotension in Adults: Exploring Insulin Dynamics During a Mixed Meal Test

Background/Objectives: Postprandial hypotension (PPH) is an important clinical condition in patients presenting with postprandial symptoms. The aims of this study were to determine the prevalence of PPH in patients with postprandial symptoms and to investigate the relationship between PPH and insulin, particularly in healthy adults. Methods: This study was conducted with 111 adult patients who were admitted to the clinic due to postprandial symptoms. Patients underwent the mixed meal test (MMT). Blood glucose, insulin, and C-peptide levels were measured at 0, 30, 60, 90, 120, 180, 240, and 300 min along with systolic blood pressure (sBP), diastolic blood pressure (dBP), and heart rate measurements during the MMT. Results: Serum adrenocorticotropic hormone (ACTH) levels were similar (p > 0.05), and cortisol levels were found to be higher in individuals without PPH compared to those with PPH before the MMT (p = 0.014). During the MMT, 23 patients (23.2%) had PPH. At the beginning of the test, serum glucose, insulin, C-peptide, and heart rate values were similar in patients with and without PPH; however sBP and dBP were significantly higher in the PPH group (p = 0.002 and p = 0.010, respectively). No correlation was found between sBP and insulin, glucose, and C-peptide at any time during the MMT except for a moderately significant positive correlation between glucose and sBP at 90 min in patients with PPH (r = 0.490, p = 0.018). A moderately negative correlation was found between the magnitude of sBP fall between 30 and 60 min and insulin and C-peptide levels in people with PPH (r = -0.420, p = 0.046; r = -0.564, p = 0.005; respectively). However, no significant relationships were observed between the magnitude of sBP fall at other time points and blood parameters (p > 0.05). Conclusions: A significant portion of adults with postprandial symptoms might have PPH, contributing to these symptoms. The lack of a relationship between insulin and glucose suggests that other physiological mechanisms beyond insulin and glucose may play a role in the pathogenesis of PPH in healthy individuals. Therefore, further research is needed to better understand the underlying causes of PPH.

Postprandial Hypotension in Elderly Patients: Pathophysiology, Diagnosis and Prevention Measures

Postprandial hypotension (PPH) is an important but underrecognized condition resulting from an inadequate compensatory cardiovascular response to meal-induced visceral blood pooling. PPG is recognized as an important clinical problem because it has a high prevalence in the older age group and is associated with the development of cardiovascular complications and geriatric syndromes. Possible pathophysiological mechanisms of PPG: increased visceral blood flow; weakening of baroreflex function due to disorders associated with age or autonomic dysfunction; inappropriate activation of sympathetic nerves; dysregulation of vasoactive intestinal peptides; insulin-mediated vasodilation. Ask about symptoms of postprandial hypotension and a decrease in systolic blood pressure (BP) of ≥20 mm Hg. Art. 15-60 minutes after eating is of paramount importance for making a diagnosis of PPG. One of the main strategies for preventing PPG is to reduce gastric distension (small meals and more frequent meals), resting on your back after eating, and drinking enough water. Walking after eating also appears to help restore blood pressure after eating. Caution should be exercised when prescribing protein supplements in the elderly, modifying the diet by replacing high-nutrient sweeteners with low-calorie sweeteners (d-xylose, xylitol, erythritol, maltose, maltodextrin, and tagatose). Metformin or acarbose modulates the cardiovascular response in patients with diabetes mellitus and reduces postprandial hypotension. Thus, PPG is a fairly common and clinically significant phenomenon in elderly patients. Increasing the awareness of doctors about pathophysiology and methods of diagnosis and prevention will improve the efficiency and safety of managing geriatric patients.