Postprandial hypotension is a condition in which a person's blood pressure drops after eating. ('Postprandial' means 'after a meal'). For people with postprandial hypotension, simply standing up after a meal can cause a particularly sharp drop in blood pressure, leading to severe symptoms.
Postprandial hypotension is seen more frequently in the elderly. About one in three older people suffers from postprandial hypotension to some degree, defined as a drop in systolic blood pressure of up to 20 mm Hg. within two hours after the meal .
Most of these people are mild and are not associated with symptoms. In some, however, postprandial hypotension can become quite severe.
Postprandial hypotension is a form of orthostatic hypotension (a drop in blood pressure when standing up). All types of orthostatic hypotension are more likely to occur in people with high blood pressure or certain conditions that disrupt the autonomic nervous system, such as Parkinson's disease and diabetes .
Postprandial hypotension symptoms
Symptoms tend to be worse after a large meal, a meal that contains a lot of carbohydrates, or if alcohol is consumed with or before meals. These symptoms generally resolve within two hours of eating.
Causes of postprandial hypotension
Although the cause of postprandial hypotension is not fully understood, it is believed to be associated with the accumulation of blood in the abdominal organs during digestion.
As a result of this accumulation, the amount of blood available for general circulation is reduced, causing a drop in blood pressure. This effect is enhanced when standing up. especially standing up.
Some accumulation of blood in the abdominal organs after a meal is normal, since the digestion of food requires increased blood flow. To compensate for this, the blood vessels in the legs naturally contract by reflex.
It is believed that with postprandial hypotension, the blood volume in the intestine is exaggerated or the normal vasoconstriction of the lower extremities is reduced.
High carbohydrate foods
Eating a high-carbohydrate diet appears to make postprandial hypotension worse. This observation has led some experts to speculate that in people with postprandial hypotension, insulin or other blood chemicals released in response to a carbohydrate-rich meal can cause abdominal blood vessels to dilate too much.
To some extent, aging itself is accompanied by an increase in the volume of blood in the abdominal cavity, which usually occurs after a meal. Most older people never develop symptoms from this increased blood collection, but people who have severe symptoms of postprandial hypotension tend to be older.
Although there is no specific treatment for postprandial hypotension, symptoms can be adequately controlled in the vast majority of people with this condition .
Treatment of symptoms of postprandial hypotension involves four elements:
- Eat less and more often. Large meals tend to increase the accumulation of blood in the abdominal cavity. Less food means less blood collection.
- Avoid foods rich in carbohydrates.
- Avoid drinking alcohol. Alcohol relaxes the blood vessels and prevents the narrowing of the blood vessels in the legs, which generally compensates for the accumulation of blood in the abdomen.
- Remain seated or, if symptoms are severe, lie down for an hour or two after eating. The accumulation of blood in the abdomen tends to dissipate during this time after eating.
If these measures are not enough, other therapies commonly used to treat orthostatic hypotension often help. This includes:
- NSAIDs : Taking non-steroidal anti-inflammatory drugs (NSAIDs) before meals can cause salt retention, which increases blood volume.
- Caffeine : This can narrow the blood vessels and reduce symptoms.
- Guar gum : This thickener can slow stomach emptying after a meal, helping to relieve symptoms.
- Exercise : Exercise between meals, such as walking, can improve vascular tone and reduce symptoms of postprandial hypotension.
If symptoms are severe and cannot be controlled by other methods, subcutaneous injections of octreotide (a drug that behaves like the pancreatic hormone somatostatin) before meals can help reduce the amount of blood flowing into the intestines.
However, this treatment is quite expensive and can lead to serious side effects.
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Although postprandial hypotension can sometimes be a serious problem, especially in the elderly, in the vast majority of people with this condition, symptoms can be controlled with some lifestyle changes.