Postprandial Hypotension Predicts All‐Cause Mortality in Older, Low‐Level Care Residents

Fisher, Alexander A.; Davis, Michael W.; Srikusalanukul, Wichat; Budge, Marc

doi:10.1111/j.1532-5415.2005.53415.x

Cited by 111 publications

(107 citation statements)

References 43 publications

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“…Phase 3 studies focusing on the blood-glucose-lowering effects of GLP-1 agonists indicate durable, modest reductions in systolic and, less consistently, diastolic blood pressure (BP), and a slight rise in heart rate (HR) [4][5][6][7]. Postprandial hypotension (PPH), defined as a fall in systolic BP ≥20 mmHg within 2 h of a meal [8], is a common disorder, associated with substantial morbidity and increased mortality [9], for which current management is suboptimal [10]. Groups most affected are older individuals, particularly those in residential care, and patients with autonomic dysfunction, including those with diabetes [10].…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…Postprandial hypotension (decreased systolic blood pressure ≥20 mmHg or in systolic blood pressure <90 mmHg when previously ≥100 mmHg within 2 hours after meal) is common in institutionalized older adults (>75 years old) 1,4 contributing to syncope, falls, cardiac events/ stroke, and increased mortality [2][3][4][5][6][7][8] . Proposed mechanisms include blunted gastrovascular sympathetic reflex post-meal 9,10 …”

Section: Introductionmentioning

confidence: 99%

Postprandial hypotension is attenuable with Acarbose treatment in older adults with diabetes mellitus type 2: a randomized controlled crossover cohort study

Harris¹,

Lockhart²,

Meneilly³

et al. 2013

EJEA

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Postprandial hypotension (PPH) is common in older adults and those with autonomic dysfunction, commonly with Diabetes Mellitus (DM).This study proposed to demonstrate that Acarbose, an α-glucosidase inhibitor, decreases the degree of PPH in an elderly DM cohort. 15 adults (9 women, 6 men) with average age of 76.06 years (range: 67-85.2) with DM type 2 (Duration: 8.7 years±7.4 ; Hemoglobin A 1 C 6.9%±0.8) attended a treatment and placebo session (separate days at least two weeks apart) in random double-blinded order. Subjects were fed a standardized meal (4 o C) and then continuously monitored over 90 minutes for blood pressure by Finometry, heart rate by Electrocardiogram, and middle cerebral artery blood flow velocity by transcranial Doppler Sonogram (20-minute baseline recorded for all measurements), blood glucose and catecholamine measurements. The frequency of PPH occurring per study was 0.8 (range: 1-3) for Acarbose and 1.46 (range: 0-3) for placebo (p=0.0359). The hemodynamic response of systolic blood pressure (SBP) and mean arterial pressure (MAP) (baseline as covariante) was significantly different by mixed-model repeated measures two-factor (time and treatment) analysis of variance (SBP: p=0.0295; MAP: p=0.0354). This is the first study to demonstrate Acarbose attenuates PPH in adults with DM. Our results suggest that acarbose is a potential therapy for PPH in older adults with DM type 2. The reported higher prevalence of PPH in our study warrants further investigation.

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“…The prevalence in institutionalized elders has been estimated at 25%-38% [17] although a study in Holland reported a prevalence of 67% amongst geriatric patients [44]. One study concluded that "in older low-level-care residents, postprandial hypotension is an independent predictor of all-cause mortality with no added predictive value explained by other blood pressure indices: orthostatic hypotension, hypertension, pulse pressure or mean arterial pressure" [18]. As Artemisia absinthium and Gentiana lutea increase vascular peripheral resistance, which acts to increase blood pressure and reduce cardiac workload they have the potential to reduce the burden of postprandial hypotension.…”

Section: Gastroparesismentioning

confidence: 99%

“…Postprandial hypotension is defined as a drop in systolic pressure of ≥ 20 mmHg, or a decrease below 90 mmHg, within 2 hours of eating. Postprandial hypotension can result in falls, syncope, coronary events and strokes [17] and it is associated with both coronary events and overall mortality [18,19] …”

Section: Oropharyngeal Taste Physiologymentioning

confidence: 99%

The Use of Bitter Herbs in Practice

McMullen¹

2017

IJCAM

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The use of bitter herbs in treatment of digestive disorders is common to many traditional healing systems. This article will reason that improvements of wellbeing after ingesting bitters are due to reflex physiological responses elicited by oral receptors. Any improvement is certainly not a placebo effect even if science has had been slow in determining the bitter tastant mechanism of activity. The article gives an update on oropharyngeal taste physiology, an overview of the digestive process emphasizing postprandial hyperemia, an evidence based critical review of the suggested mechanisms by which bitters support digestion and suggestions as to when and why bitters can be applied for digestive and cardiovascular problems. Through understanding the mechanism by which traditional medicines work, we can both substantiate traditional usage and refine our tools. This knowledge allows us to extend traditional preparations to other pathologies. Our traditional knowledge base is large, but to investigate it we need experimental models sensitive enough to detect physiological changes that do not involve agents that block physiological activity. The studies presented in this article give only a glimpse of the effect bitters have on the body. Much is still to be discovered within the chemosensory world of tastants.

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Postprandial Hypotension Predicts All‐Cause Mortality in Older, Low‐Level Care Residents

Abstract: In older low-level-care residents, PPH is an independent predictor of all-cause mortality with no added predictive value explained by other BP indices: OH, hypertension, PP, MAP.

Cited by 111 publications

References 43 publications

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 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

Postprandial hypotension is attenuable with Acarbose treatment in older adults with diabetes mellitus type 2: a randomized controlled crossover cohort study

The Use of Bitter Herbs in Practice

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