Postprandial hypotension (PPH) is a condition in which there is a systolic blood pressure drop of 20 mm Hg in a supine/sitting position within 120 minutes after eating a meal.[27,28] PPH occurs more often than PH, and infrequently together with PH, among older adults. In their study of 85 frail hospitalized older adults, Vloet et al. found that 67% had PPH and 52% had PH. Studies from long-term care facilities had shown the prevalence of PPH at 24-36%.[30,31]
Splanchnic dilatation after a meal is the most important factor for PPH. Sympathetic activity after a meal should increase two to three times to prevent PPH. An inadequate postprandial increase in cardiac output can be due to an impairment of baroreflex function and inadequate compensation of the sympathetic nervous system. An increased release of vasodilatory gastrointestinal peptide-like calcitonin gene-related peptide (CGRP) may play a role in the pathogenesis of PPH. PPH is also related to the rate of glucose entry into the duodenum. PPH is seen more commonly in among individuals with diabetes, hypertension, with Parkinson's disease, and those assigned to dialysis (see Table 1 ).
Blood pressure should be checked before the meal in the lying position after 5 minutes of rest. Blood pressure should be checked at 15, 30, 60, 75, 90, and 120 minutes in the lying position. In 15% of individuals with PPH, the blood pressure drop is seen 15 minutes after eating; in 70%, it is seen within 30-60 minutes. In the remaining 15%, the blood pressure drop is seen 75-120 minutes after eating. A higher prevalence of PPH is seen after breakfast; therefore, the evaluation of PPH is preferable before and after breakfast.[40,41] Ambulatory blood pressure monitoring is helpful in diagnosing PPH. The symptoms associated with PPH include sleepiness, nausea, headache, TIA, and chest pain.
Geriatrics and Aging. 2007;10(5):298-304. © 2007 1453987 Ontario, Ltd.
Cite this: Postural and Postprandial Hypotension: Approach to Management - Medscape - May 01, 2007.