Effects of gastric distension on blood pressure and superior mesenteric artery blood flow responses to intraduodenal glucose in healthy older subjects

Vanis, Lora; Gentilcore, Diana; Hausken, Trygve; Pilichiewicz, Amelia N.; Lange, Kylie; Rayner, Christopher K.; Feinle‐Bisset, Christine; Meyer, James H.; Horowitz, Michael

doi:10.1152/ajpregu.00235.2010

Cited by 27 publications

(46 citation statements)

References 37 publications

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“…2008; Vanis et al. 2010). That the fall in BP is less following oral, when compared with an identical duodenal, glucose load, in healthy older subjects is likely to reflect the “protective” effects of gastric distension (Gentilcore et al.…”

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Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

et al. 2017

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Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH. We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH. Eight healthy older subjects (age 71.0 ± 1.7 years) and eight subjects with PPH (age 75.5 ± 1.0 years) consumed a 300 mL drink of either water or 75 g glucose (including 150 mg 13C‐acetate) in randomized order. BP and heart rate (HR) were measured using an automatic device, SV, CO, and GLS by transthoracic echocardiography and gastric emptying by measurement of 13 CO 2. In both groups, glucose decreased systolic BP (P < 0.001) and increased HR, SV, and CO (P < 0.05 for all). The fall in systolic BP was greater (P < 0.05), and increase in HR less (P < 0.05), in the PPH group, with no difference in SV or CO. Water increased systolic BP (P < 0.05) in subjects with PPH and, in both groups, decreased HR (P < 0.05) without affecting SV, CO, or GLS. In subjects with PPH, the hypotensive response to glucose and the pressor response to water were related (R = −0.75, P < 0.05). These observations indicate that, in PPH, the hypotensive response to oral glucose is associated with inadequate compensatory increases in CO and HR, whereas the pressor response to water ingestion is maintained and, possibly, exaggerated.

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Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

et al. 2017

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“…In healthy older individuals and patients with type 2 diabetes, the postprandial fall in BP and increase in superior mesenteric artery (SMA) blood flow are greater when the rate of gastric emptying (GE), or intraduodenal glucose infusion, is relatively faster [11,12], while gastric distension attenuates the fall in BP [13]. GE in healthy individuals exhibits a wide interindividual variation of~4-17 kJ/min (~1-4 kcal/min) [14]; this is increased in diabetes because of the high prevalence of delayed [15], and occasionally rapid, GE [16].…”

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confidence: 99%

Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes

et al. 2015

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Aims/hypothesis A postprandial fall in BP occurs frequently in older individuals and in patients with type 2 diabetes. The magnitude of this decrease in BP is related to the rate of gastric emptying (GE). Intravenous administration of glucagon-like peptide-1 (GLP-1) attenuates the hypotensive response to intraduodenal glucose in healthy older individuals. We sought to determine the effects of exogenous GLP-1 on BP, GE, superior mesenteric artery (SMA) flow and glycaemic response to oral ingestion of glucose in healthy older individuals and patients with type 2 diabetes. Methods Fourteen older volunteers (six men, eight women; age 72.1±1.1 years) and ten patients with type 2 diabetes (six men, four women; age 68.7±3.4 years; HbA 1c 6.6±0.2% [48.5± 2.0 mmol/mol]; nine with blood glucose managed with metformin, two with a sulfonylurea and one with a dipeptidyl-peptidase 4 inhibitor) received an i.v. infusion of GLP-1 (0.9 pmol kg −1 min −1 ) or saline (154 mmol/l NaCl) for 150 min (t=−30 min to t= 120 min) in randomised order. At t=0 min, volunteers consumed a radiolabelled 75 g glucose drink. BP was assessed with an automated device, GE by scintigraphy and SMA flow by ultrasonography. Blood glucose and serum insulin were measured. Results GLP-1 attenuated the fall in diastolic BP after the glucose drink in older individuals (p<0.05) and attenuated the fall in systolic and diastolic BP in patients with type 2 diabetes (p<0.05). GE was faster in patients with type 2 diabetes than in healthy individuals (p<0.05). In both groups, individuals had slower GE (p<0.001), decreased SMA flow (p<0.05) and a lower degree of glycaemia (p<0.001) when receiving GLP-1. Conclusions/interpretation Intravenous GLP-1 attenuates the hypotensive response to orally administered glucose and decreases SMA flow, probably by slowing GE. GLP-1 and 'short-acting' GLP-1 agonists may be useful in the management of postprandial hypotension.

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“…In contrast, in healthy young subjects, intraduodenal glucose infusions at 1, 2, or 3 kcal/min have no effect on blood pressure (41). In contrast to the effects of small intestinal nutrients, gastric distension attenuates the postprandial fall in blood pressure (35,38,44,46). It was initially reported that gastric distension with a balloon linked to a "barostat" device has the capacity to increase blood pressure in healthy young (35) and older (44, 46) subjects.…”

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“…Information about the effects of gastric distension on SMA blood flow in animals and humans is limited and inconsistent, ranging from no effect (43) to increases (11, 25, 43) and decreases (30,43,46).…”

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“…In contrast to the effects of small intestinal nutrients, gastric distension attenuates the postprandial fall in blood pressure (35,38,44,46). It was initially reported that gastric distension with a balloon linked to a "barostat" device has the capacity to increase blood pressure in healthy young (35) and older (44,46) subjects. More recently, using a barostat set to a pressure of 8 mmHg above minimal distending pressure (MDP), resulting in variable intragastric volumes ranging from 400 to 900 ml, we reported that gastric distension markedly attenuates the hypotensive response to a 3 kcal/min intraduodenal glucose infusion in healthy older subjects (46).…”

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Effects of variations in intragastric volume on blood pressure and splanchnic blood flow during intraduodenal glucose infusion in healthy older subjects

Vanis

Gentilcore

Lange

et al. 2012

American Journal of Physiology-Regulatory, Integrative and Comp

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(BP) is triggered by the interaction of nutrients with the small intestine and associated with an increase in splanchnic blood flow. Gastric distension may attenuate the postprandial fall in BP. The aim of this study was to determine the effects of differences in intragastric volume, including distension at a low (100 ml) volume, on BP and superior mesenteric artery (SMA) blood flow responses to intraduodenal glucose in healthy older subjects. BP and heart rate (HR; automated device), SMA blood flow (Doppler ultrasound), mesenteric vascular resistance (MVR), and plasma norepinephrine of nine male subjects (65-75 yr old) were measured after an overnight fast on 4 separate days in random order. On each day, subjects were intubated with a nasoduodenal catheter, incorporating a duodenal infusion port, and orally with a second catheter, incorporating a barostat bag, positioned in the fundus. Each subject received a 60-min (t ϭ 0 -60 min) intraduodenal glucose infusion (3 kcal/min) and gastric distension at a volume of 1) 0 ml (V0), 2) 100 ml (V100), 3) 300 ml (V300), or 4) 500 ml (V500). Systolic BP fell (P Ͻ 0.05) during V0, but not during V100, V300, or V500. In contrast, HR (P Ͻ 0.01) and SMA blood flow (P Ͻ 0.001) increased and MVR decreased (P Ͻ 0.05) comparably on all 4 days. Plasma norepinephrine rose (P Ͻ 0.01) in response to intraduodenal glucose, with no difference between the four treatments. There was a relationship between the areas under the curve for the change in systolic BP from baseline with intragastric volume (r ϭ 0.60, P Ͻ 0.001). In conclusion, low-volume (Յ100 ml) gastric distension has the capacity to abolish the fall in BP induced by intraduodenal glucose in healthy older subjects without affecting SMA blood flow or MVR. These observations support the concept that nonnutrient gastric distension prior to a meal has potential therapeutic applications in the management of postprandial hypotension.barostat; distension; postprandial hypotension POSTPRANDIAL HYPOTENSION is an important clinical problem, particularly in the elderly (17,27). It is distinct from, and may occur more frequently than, orthostatic hypotension and represents a substantial cause of morbidity and mortality (17). While the mechanisms underlying postprandial hypotension are poorly defined, several interrelated factors, including meal composition, gastric distension, the rate of small intestinal nutrient delivery, changes in splanchnic blood flow, and neural and hormonal mechanisms, have been identified (17, 39). In the elderly, it is likely that "normality" and postprandial hypotension represent a continuum, as is the case with many age-related phenomena. For example, after an oral glucose load, systolic blood pressure predictably falls in healthy older, but not young, subjects, and in the elderly the magnitude of this decrease is variable (18).Our previous studies established that, in healthy older subjects and patients with type 2 diabetes, the magnitude of the fall in blood pressure in response to enteral glucose is depend...

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Effects of gastric distension on blood pressure and superior mesenteric artery blood flow responses to intraduodenal glucose in healthy older subjects

Cited by 27 publications

References 37 publications

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes

Effects of variations in intragastric volume on blood pressure and splanchnic blood flow during intraduodenal glucose infusion in healthy older subjects

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