Postural and Postprandial Hypotension: Approach to Management

Kannayiram Alagiakrishnan, MD, MPH, FRCPC, ABIM

Disclosures

Geriatrics and Aging. 2007;10(5):298-304. 

In This Article

Postprandial Hypotension

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.[29] In their study of 85 frail hospitalized older adults, Vloet et al. found that 67% had PPH and 52% had PH.[1] 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.[32] Sympathetic activity after a meal should increase two to three times to prevent PPH.[33] An inadequate postprandial increase in cardiac output can be due to an impairment of baroreflex function and inadequate compensation of the sympathetic nervous system.[28] An increased release of vasodilatory gastrointestinal peptide-like calcitonin gene-related peptide (CGRP) may play a role in the pathogenesis of PPH.[34] PPH is also related to the rate of glucose entry into the duodenum.[35] PPH is seen more commonly in among individuals with diabetes,[36] hypertension,[37] with Parkinson's disease,[38] and those assigned to dialysis (see Table 1 ).[39]

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.[42] The symptoms associated with PPH include sleepiness, nausea, headache, TIA, and chest pain.[1]

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