Postprandial hypotension treated with acarbose in a patient with type 1 diabetes mellitus

Maule, Simona; Tredici, M; Dematteis, A.; Matteoda, C.; Chiandussi, L

doi:10.1007/s10286-004-0220-0

Cited by 17 publications

(20 citation statements)

References 13 publications

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“…The glycemic responses to intraduodenal glucose were comparable in studies with and without gastric distension (8). Furthermore, insulin is unlikely to play a major role in postprandial hypotension, since intravenous glucose has little, if any, effect on blood pressure, and postprandial hypotension occurs in type 1 diabetic patients (23,25), who are, by definition, insulin-deficient. The observed effects of gastric distension on the stimulation of SMA blood flow are of considerable interest, particularly given the paucity of previous information.…”

Section: Discussionmentioning

confidence: 89%

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

Vanis

Gentilcore

Hausken

et al. 2010

American Journal of Physiology-Regulatory, Integrative and Comp

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Postprandial hypotension occurs frequently and is associated with increased morbidity. Gastric distension may attenuate the postprandial fall in blood pressure (BP). Using a barostat, we sought to determine the effects of gastric distension on BP, heart rate (HR), and superior mesenteric artery (SMA) blood flow responses to intraduodenal glucose in eight (6 men, 2 women) healthy older (65-75 yr old) subjects. BP and HR were measured using an automated device and SMA blood flow was measured using Doppler ultrasound on 4 days in random order. SMA blood flow was calculated using the radius of the SMA and time-averaged mean velocity. Subjects were intubated with a nasoduodenal catheter incorporating a duodenal infusion port. On 2 of the 4 days, they were intubated orally with a second catheter, incorporating a barostat bag, positioned in the fundus and set at 8 mmHg above minimal distending pressure. Each subject received a 60-min (0-60 min) intraduodenal infusion of glucose (3 kcal/min) or saline (0.9%); therefore, the four study conditions were as follows: intraduodenal glucose + barostat (glucose + distension), intraduodenal saline + barostat (saline + distension), intraduodenal glucose (glucose), and intraduodenal saline (saline). Systolic and diastolic BP fell during glucose compared with saline (P = 0.05 and P = 0.003, respectively) and glucose + distension (P = 0.01 and P = 0.05, respectively) and increased during saline + distension compared with saline (P = 0.04 and P = 0.006, respectively). The maximum changes in systolic BP were -14 +/- 5, +11 +/- 2, -3 +/- 4, and +15 +/- 3 mmHg for glucose, saline, glucose + distension, and saline + distension, respectively. There was an increase in HR during glucose and glucose + distension (maximum rise = 14 +/- 2 and 14 +/- 3 beats/min, respectively), but not during saline or saline + distension. SMA blood flow increased during glucose and glucose + distension (2,388 +/- 365 and 1,673 +/- 187 ml/min, respectively), but not during saline, and tended to decrease during saline + distension (821 +/- 115 and 864 +/- 116 ml/min, respectively). In conclusion, gastric distension has the capacity to abolish the fall in BP and attenuate the rise in SMA blood flow induced by intraduodenal glucose in healthy older subjects.

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Section: Discussionmentioning

confidence: 89%

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

Vanis

Gentilcore

Hausken

et al. 2010

American Journal of Physiology-Regulatory, Integrative and Comp

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“…This was, however, important to exclude, as hyperglycemia (2,26), including variations in blood glucose that are within the normal postprandial range (1,37), affects gastric motility. While elevations in blood glucose and insulin appear unlikely to play a major role in postprandial hypotension, since intravenous glucose has little, if any, effect on blood pressure and postprandial hypotension occurs in type 1 diabetic patients, who are, by definition, insulin-deficient (27,28), this does not discount the relevance of potential hormonal factors. An increase in sympathetic activity may potentially account for the effects of gastric distension, particularly as gastric distension has been shown to increase muscle sympathetic nerve activity in healthy young and older subjects, although the magnitude of the increase was less in the elderly (44).…”

Section: Discussionmentioning

confidence: 99%

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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“…These findings are consistent with previous observations that patients with type 1 diabetes mellitus who, by definition, are insulin deficient, also develop PPH. 24 The action of acarbose on glucose absorption affects a common pathway that influences the secretion of other gut hormones with known vasodilatory actions, such as neurotensin. 26,41 It is likely that more than one vasodilator is involved in the pathophysiology of PPH.…”

Section: Discussionmentioning

confidence: 99%

“…Two case reports found improvement of PPH in patients with type 1 24 and type 2 25 diabetes mellitus. Furthermore, Maruta et al 26 showed that voglibose, another ␣-glucosidase inhibitor, also attenuates PPH in patients with neurologic disorders, such as multiple system atrophy and Parkinson disease.…”

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confidence: 99%

Acarbose, an α-Glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure

et al. 2007

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Abstract-Postprandial hypotension is an important clinical condition that predisposes to syncope, falls, angina, and cerebrovascular events. The magnitude of the fall in blood pressure after meals depends on enteric glucose availability. We hypothesized that acarbose, an ␣-glucosidase inhibitor that decreases glucose absorption in the small intestine, would attenuate postprandial hypotension. Acarbose or placebo was given 20 minutes before a standardized meal in 13 patients with postprandial hypotension in the setting of autonomic failure (age: 65Ϯ2.64 years; body mass index: 25Ϯ1.08 kg/m 2 ; supine plasma norepinephrine: 110Ϯ26.6 pg/mL). Four patients were studied in a single-blind protocol and 9 patients in a double-blind, randomized, crossover fashion. Patients were studied supine, and blood pressure, heart rate, and neuroendocrine parameters were obtained at baseline and for 90 minutes after meal intake. After adjusting for potential confounders, acarbose significantly attenuated the postprandial fall in systolic and diastolic blood pressures by 17 mm Hg (95% CI: 7 to 28; Pϭ0.003) and 9 mm Hg (95% CI: 5 to 14; Pϭ0.001), respectively. Furthermore, acarbose effectively reduced plasma levels of insulin, a known vasodilator, by 11 U/mL (95% CI: 5 to 18; Pϭ0.001) compared with placebo. After adjusting for insulin levels, the attenuation of postprandial hypotension by acarbose remained significant, indicating that additional mechanisms contribute to this effect. In conclusion, 100 mg of acarbose successfully improved postprandial hypotension in patients with severe autonomic failure. This effect is not explained solely by a reduction in insulin levels. Key Words: postprandial Ⅲ hypotension Ⅲ acarbose Ⅲ ␣-glucosidase inhibitor Ⅲ autonomic nervous system diseases Ⅲ autonomic failure P ostprandial hypotension (PPH), defined as a fall in systolic blood pressure (SBP) of Ͼ20 mm Hg occurring within 2 hours after a meal, 1,2 is an important clinical problem that predisposes to syncope, falls, angina pectoris, and cerebrovascular events. 3,4 The clinical presentation is characterized by symptoms of lightheadedness with an onset within 30 minutes after food ingestion. 5 The magnitude of the decrease in blood pressure depends on the size of the meal 6 and its composition 4,7 ; PPH is more severe the greater the carbohydrate content. 8 Those most affected are patients with some degree of autonomic impairment, suggesting that, in healthy subjects, the hypotensive effect of meals is buffered by the autonomic nervous system. PPH has been reported in healthy elderly persons, 9,10 elderly patients with hypertension, 11-13 elderly residents of nursing homes, 14,15 patients with Parkinson disease, 16 -18 and patients with diabetes mellitus. 19 PPH is particularly severe in patients suffering from primary forms of autonomic failure. 1 The pathogenesis of PPH is likely multifactorial. Gastrointestinal and pancreatic hormones with vasodilatory properties seem to play a key role. These are released into the bloodstream in response to ...

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Postprandial hypotension treated with acarbose in a patient with type 1 diabetes mellitus

Abstract: Treatment of postprandial hypotension (PPH) is often unsuccessful. We report a case of a type 1 diabetic patient suffering from severely symptomatic PPH. The patient was treated with acarbose and showed definite improvement of both glycemic control and PPH.

Cited by 17 publications

References 13 publications

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

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

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

Acarbose, an α-Glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure

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