Combination Therapy for Postprandial and Orthostatic Hypotension in an Elderly Patient With Type 2 Diabetes Mellitus

Yamamoto, Naomune; Sasaki, Eun; Arishima, Takeshi; M, Ito; Tanaka, Hidetaka; Terasaki, Jungo; Imagawa, Akihisa; Hanafusa, Toshiaki

doi:10.1111/j.1532-5415.2006.00668_13.x

Cited by 7 publications

(10 citation statements)

References 8 publications

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“…The reduced falling magnitude, duration, and blood pressure fluctuations observed in the present study with acarbose are similar to previous case reports and randomized controlled studies of acarbose in elderly patients with diabetes 3 8 11 15. Furthermore, the attenuation of PPH by acarbose was also observed in patients with severe autonomic failure 16.…”

Section: Discussionsupporting

confidence: 91%

Effectiveness of Acarbose in Treating Elderly Patients with Diabetes with Postprandial Hypotension

Zhang

Guo

2017

Journal of Investigative Medicine

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Section: Discussionsupporting

confidence: 91%

Effectiveness of Acarbose in Treating Elderly Patients with Diabetes with Postprandial Hypotension

Zhang

Guo

2017

Journal of Investigative Medicine

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“…Favorable effects were also demonstrated in an open-label study in patients with MSA ( n = 14) (Fukushima et al 2013 ) and case reports (type 1 diabetes mellitus) (Maule et al 2004 ) (type 2 diabetes mellitus) (Yamamoto et al 2006 ; Sasaki et al 2001 ).…”

Section: Treatment Of Noh and Related Symptoms: Classification Of Evimentioning

confidence: 82%

Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms

2017

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Neurogenic orthostatic hypotension, postprandial hypotension and exercise-induced hypotension are common features of cardiovascular autonomic failure. Despite the serious impact on patient’s quality of life, evidence-based guidelines for non-pharmacological and pharmacological management are lacking at present. Here, we provide a systematic review of the literature on therapeutic options for neurogenic orthostatic hypotension and related symptoms with evidence-based recommendations according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Patient’s education and non-pharmacological measures remain essential, with strong recommendation for use of abdominal binders. Based on quality of evidence and safety issues, midodrine and droxidopa reach a strong recommendation level for pharmacological treatment of neurogenic orthostatic hypotension. In selected cases, a range of alternative agents can be considered (fludrocortisone, pyridostigmine, yohimbine, atomoxetine, fluoxetine, ergot alkaloids, ephedrine, phenylpropanolamine, octreotide, indomethacin, ibuprofen, caffeine, methylphenidate and desmopressin), though recommendation strength is weak and quality of evidence is low (atomoxetine, octreotide) or very low (fludrocortisone, pyridostigmine, yohimbine, fluoxetine, ergot alkaloids, ephedrine, phenylpropanolamine, indomethacin, ibuprofen, caffeine, methylphenidate and desmopressin). In case of severe postprandial hypotension, acarbose and octreotide are recommended (strong recommendation, moderate level of evidence). Alternatively, voglibose or caffeine, for which a weak recommendation is available, may be useful.

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“…In a small study (n = 9), acarbose attenuated PPH in a young population without diabetes mellitus with severe autonomic failure; acarbose also attenuated normal postprandial physiological changes (n = 8) in older adults without PPH . The only investigations of acarbose in older adults with PPH were found in case reports . To the knowledge of the authors of the current study, this study was the first to demonstrate that a single dose of an alpha‐glucosidase inhibitor elevates postprandial blood pressure, resulting in a reduction in the number of PHEs in older adults with PPH.…”

Section: Resultsmentioning

confidence: 68%

Attenuation of Postprandial Hypotension with Acarbose in Older Adults with Type 2 Diabetes Mellitus

Madden

Harris

Meneilly

2015

J American Geriatrics Society

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Combination Therapy for Postprandial and Orthostatic Hypotension in an Elderly Patient With Type 2 Diabetes Mellitus

Cited by 7 publications

References 8 publications

Effectiveness of Acarbose in Treating Elderly Patients with Diabetes with Postprandial Hypotension

Effectiveness of Acarbose in Treating Elderly Patients with Diabetes with Postprandial Hypotension

Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms

Attenuation of Postprandial Hypotension with Acarbose in Older Adults with Type 2 Diabetes Mellitus

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