Relationship between splanchnic vasodilation and postprandial hypotension in patients with primary autonomic failure

Kooner, Jaspal S.; Raimbach, Sarah; Watson, Laura; Bannister, R.; Peart, Stanley; Mathias, Christopher J.

doi:10.1097/00004872-198900076-00017

Cited by 64 publications

(40 citation statements)

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“…In normal subjects, food ingestion promotes biochemical and hormonal changes, including the secretion of gastric acid and gut peptides, that result in blood pooling within the splanchnic circulation. 20,34 To maintain blood pressure, a variety of hemodynamic changes are necessary, including an increase in HR, stroke volume, and CO. 4 These responses are partially mediated by a compensatory sympathetic activation as shown by the increase in plasma norepinephrine and muscle sympathetic nerve activity after food intake in normal subjects. 5,34 Failure of these compensatory mechanisms seems pivotal in the development of PPH, explaining the greater prevalence of this condition in subjects with autonomic impairment.…”

Section: Discussionmentioning

confidence: 99%

“…These are released into the bloodstream in response to food intake and are responsible for pooling of blood in the splanchnic circulation. 20 Notably, drugs that blunt the release of these hormones, for example, octreotide, 21 or that antagonize their action, for example, caffeine, 22 attenuate PPH and are integral components of the treatment strategy for this condition.Recently, it has been proposed that acarbose, commonly used to control postprandial hyperglycemia in type 2 diabetes mellitus, 23 could potentially improve PPH. Acarbose inhibits ␣-glucosidase in the brush border of the small intestine, delaying glucose absorption by decreasing the breakdown of complex carbohydrates.…”

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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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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 2007

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“…As demonstrated by a number of studies using various techniques, meal ingestion produces marked splanchnic vasodilatation in healthy and, to a lesser degree, in cirrhotic patients, 10À15 but it also produces peripheral vasoconstriction. 16,17 Our aim was to assess by duplex Doppler sonography the changes in arterial resistance in the renal arteries and superior mesenteric artery (SMA) following splanchnic vasodilatation induced by a standard meal.…”

Section: Received 2 October 2000; Accepted 25 July 2001mentioning

confidence: 99%

Changes in renal artery resistance after meal‐induced splanchnic vasodilatation in cirrhotic patients

Perney

Taourel

Gallix

et al. 2001

J of Clinical Ultrasound

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“…Patients with different diseases causing autonomic failure (including Shy-Drager syndrome and progressive autonomic failure) have significant falls in blood pressure, without an attendant rise in forearm vascular resistance or a significant change in plasma noradrenaline concentrations (Hoeldtke et al 1986;Kooner, Raimbach, Watson, Bannister, Peart & Mathias, 1989b;Mathias, da Costa, Fosbraey, Bannister, Wood, Bloom & Christensen, 1989;Lipsitz et al 1993). Falls and syncope in these often elderly patients can have serious implications (Lipsitz, Jonsson, Kelley & Koestner, 1991).…”

Section: Autonomic Failurementioning

confidence: 99%

The cardiovascular responses to feeding in man

Kearney¹,

Cowley²,

Macdonald³

1995

Experimental Physiology

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Relationship between splanchnic vasodilation and postprandial hypotension in patients with primary autonomic failure

Cited by 64 publications

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

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

Changes in renal artery resistance after meal‐induced splanchnic vasodilatation in cirrhotic patients

The cardiovascular responses to feeding in man

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