Research progress of postprandial hypotension and its relationship with cardiovascular and cerebrovascular damage in the elderly

doi:10.16138/j.1673-6087.2024.05.11

Abstract

Abstract:

The most common hypotensive syndromes in the elderly include orthostatic hypotension (OH), postprandial hypotension (PPH), carotid sinus syndrome, and vasovagal syncope type 1. Among them, PPH has a higher incidence. PPH was formally proposed in 1977, and evolving evidence suggests that PPH is a risk factor for different cardiovascular diseases. PPH is associated with cardiovascular disease and all-cause mortality in the elderly, but is often overlooked due to atypical symptoms. This article reviews the latest research progress of PPH and its relationship with cardiovascular and cerebrovascular damage in the elderly.

Key words: Elderly people, Postprandial hypotension, Cardiovascular and cerebrovascular damage, Epidemiology

CLC Number:

R544.2

XIE Xiaomeng, GONG Yanchun. Research progress of postprandial hypotension and its relationship with cardiovascular and cerebrovascular damage in the elderly[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(05): 342-346.

Figures/Tables 1

References 58

[1]	Alagiakrishnan K. How can we better manage hypotensive syndromes in older adults?[J]. Expert Rev Cardiovasc Ther, 2022, 20(7):503-505.
[2]	Jenkins DJA, Sahye-Pudaruth S, Khodabandehlou K, et al. Systematic review and meta-analysis examining the relationship between postprandial hypotension, cardio-vascular events, and all-cause mortality[J]. Am J Clin Nutr, 2022, 116(3):663-671. doi: 10.1093/ajcn/nqac158 pmid: 35675216
[3]	Jansen RW, Lipsitz LA. Postprandial hypotension: epidemiology, pathophysiology, and clinical management[J]. Ann Intern Med, 1995, 122(4):286-295. pmid: 7825766
[4]	Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension[J]. Am J Med, 2010, 123(3):281.
[5]	唐敏, 苏海. 如何诊断高血压患者的餐后低血压[J]. 中华高血压杂志, 2022, 30(12):1240-1242.
[6]	Madden KM, Feldman B, Meneilly GS. Blood pressure measurement and the prevalence of postprandial hypotension[J]. Clin Invest Med, 2019, 42(1):E39-E46.
[7]	Abbas R, Tanguy A, Bonnet-Zamponi D, et al. New simplified screening method for postprandial hypotension in older people[J]. J Frailty Aging, 2018, 7(1):28-33. doi: 10.14283/jfa.2018.2 pmid: 29412439
[8]	Pavelić A, Krbot Skorić M, Crnošija L, et al. Postprandial hypotension in neurological disorders: systematic review and meta-analysis[J]. Clin Auton Res, 2017, 27(4):263-271. doi: 10.1007/s10286-017-0440-8 pmid: 28647892
[9]	Schoevaerdts D, Iacovelli M, Toussaint E, et al. Prevalence and risk factors of postprandial hypotension among elderly people admitted in a geriatric evaluation and management unit : an observational study[J]. J Nutr Health Aging, 2019, 23(10):1026-1033. doi: 10.1007/s12603-019-1271-1 pmid: 31781734
[10]	Barochiner J, Alfie J, Aparicio LS, et al. Postprandial hypotension detected through home blood pressure monitoring: a frequent phenomenon in elderly hypertensive patients[J]. Hypertens Res, 2014, 37(5):438-443. doi: 10.1038/hr.2013.144 pmid: 24108236
[11]	张亚楠, 陈天磊, 耿雪, 等. 住院高血压合并冠心病患者餐后低血压的临床观察[J]. 中华医学杂志, 2018, 98(33):2641-2644.
[12]	Kitae A, Ushigome E, Hashimoto Y, et al. Asymptomatic postprandial hypotension in patients with diabetes: the KAMOGAWA-HBP study[J]. J Diabetes Investig, 2021, 12(5):837-844.
[13]	席小青, 蔡金凤, 柳达. 餐后低血压危险因素的临床研究[J]. 临床心血管病杂志, 2017, 33(12):1210-1214.
[14]	Lee JH, Hwang K, Cho M. Postprandial hypotension, is it real? the preliminary results of a pilot study[J]. J Hypertens, 2018, 36:e263.
[15]	Madden KM, Feldman B, Meneilly GS. Characteristics associated with the postprandial hypotensive response in falling older adults[J]. Can J Aging, 2019, 38(4):434-440. doi: 10.1017/S0714980818000752 pmid: 31084627
[16]	Xie C, Wang X, Jones KL, et al. Comparative effects of intraduodenal glucose and fat infusion on blood pressure and heart rate in type 2 diabetes[J]. Front Nutr, 2020, 7:582314.
[17]	Sato K, Sugiura T, Ohte N, et al. Postprandial hypotension in older people receiving tube feeding through gastrostomy[J]. Geriatr Gerontol Int, 2018, 18(10):1474-1478. doi: 10.1111/ggi.13515 pmid: 30160007
[18]	Holmes GM, Blanke EN. Gastrointestinal dysfunction after spinal cord injury[J]. Exp Neurol, 2019, 320:113009.
[19]	Hansen RM, Krogh K, Sundby J, et al. Postprandial hypotension and spinal cord injury[J]. J Clin Med, 2021, 10(7):1417.
[20]	Liu CC, Liu CC, Kanekiyo T, et al. Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy[J]. Nat Rev Neurol, 2013, 9(2):106-118.
[21]	Stewart KC, Subramanian D, Neal UJ, et al. APOE genotype influences postprandial blood pressure after high fat feeding in older adults[J]. J Nutr Health Aging, 2019, 23(5):408-413. doi: 10.1007/s12603-019-1167-0 pmid: 31021357
[22]	Lu F, Liu Y, Xiao Z, et al. Study on the effects of different postprandial positions on blood pressure and heart rate in older adults with primary hypertension and postprandial hypotension[J]. Geriatr Nurs, 2022, 46:199-205. doi: 10.1016/j.gerinurse.2022.05.016 pmid: 35749864
[23]	Madden KM, Feldman B, Meneilly GS. Baroreflex function and postprandial hypotension in older adults[J]. Clin Auton Res, 2021, 31(2):273-280.
[24]	Mitro P, Feterik K, Lenártová M, et al. Humoral mechanisms in the pathogenesis of postprandial hypotension in patients with essential hypertension[J]. Wien Klin Wochenschr, 2001, 113(11-12):424-432. pmid: 11467088
[25]	Trahair LG, Horowitz M, Jones KL. Postprandial hypotension is associated with more rapid gastric emptying in healthy older individuals[J]. J Am Med Dir Assoc, 2015, 16(6):521-523. doi: 10.1016/j.jamda.2015.01.097 pmid: 25769959
[26]	Zhang X, Jones KL, Horowitz M, et al. Effects of proximal and distal enteral glucose infusion on cardiovascular response in health and type 2 diabetes[J]. J Clin Endocrinol Metab, 2020, 105(8):dgaa341.
[27]	Ong JYY, Pathak K, Zhao Y, et al. Higher fasting fibroblast growth factor 21 was associated with a greater decline in postprandial blood pressure[J]. Diabetes Metab Syndr, 2023, 17(2):102720.
[28]	Hu H, Qiao W, Wang X, et al. Effect of blood insulin level on postprandial hypotension in elderly people[J]. Blood Press Monit, 2020, 25(4):201-205. doi: 10.1097/MBP.0000000000000450 pmid: 32404599
[29]	Wei Q, Jing L, Ying L. et al. GW27-e0647 the effect of gastrointestinal hormone on postprandial hypotension[J]. JACC, 2016, 68 (16 Suppl):C139.
[30]	隋如, 马丽, 哈利别克, 等. 老年高血压伴餐后低血压患者的血压变异性研究[J]. 世界最新医学信息文摘, 2017, 17(23):1-2.
[31]	Virtanen M, Lallukka T, Ervasti J, et al. The joint contribution of cardiovascular disease and socioeconomic status to disability retirement: a register linkage study[J]. Int J Cardiol, 2017, 230:222-227. doi: S0167-5273(16)34817-3 pmid: 28063665
[32]	Rana JS, Khan SS, Lloyd-Jones DM, et al. Changes in mortality in top 10 causes of death from 2011 to 2018[J]. J Gen Intern Med, 2021, 36(8):2517-2518.
[33]	Jang A. Postprandial hypotension as a risk factor for the development of new cardiovascular disease: a prospective cohort study with 36 month follow-up in community-dwelling elderly people[J]. J Clin Med, 2020, 9(2):345.
[34]	路岩, 朱丹, 郝宇, 等. 住院老年高血压患者伴发餐后低血压的临床观察[J]. 中华高血压杂志, 2017, 25(02):145-151.
[35]	赵伟, 侯晓, 夏营营, 等. 原发性高血压患者餐后低血压与24 h平均心率、心率变异性及颈动脉斑块的相关性研究[J]. 中国医药指南, 2022, 20(29):88-90.
[36]	王锋顺, 商黔惠, 邹焰, 等. 高血压患者伴发餐后低血压现象与颈动脉粥样硬化的关系[J]. 中华高血压杂志, 2015, 23(07):633-638.
[37]	Wenli C, Meiyue S, Li C, et al. A15995 Association between morning blood pressure surge accompanied by postprandial hypotension and vulnerability of carotid atherosclerotic plaque in senile patients with primary hypertension[J]. J Hypertens, 2018, 36:e86.
[38]	Tabara Y, Okada Y, Uetani E, et al. Postprandial hypotension as a risk marker for asymptomatic lacunar infarction[J]. J Hypertens, 2014, 32(5):1084-1090. doi: 10.1097/HJH.0000000000000150 pmid: 24695394
[39]	王晓明, 张怡楠, 曾军, 等. 老年原发性高血压患者餐后低血压与缺血性脑卒中相关性研究[J]. 国际心血管病杂志, 2023, 50(2):121-128.
[40]	Basile G, Quattropani MC, Sardella A, et al. Postprandial hypotension and impaired postprandial sustained and selective attention in older inpatients: is there a link?[J]. J Am Med Dir Assoc, 2023, 24(7):1082-1087. doi: 10.1016/j.jamda.2023.03.023 pmid: 37121263
[41]	Huang L, Cheng L, Xie X, et al. Non-pharmacological interventions for older adults with postprandial hypotension: a scoping review[J]. J Clin Nurs, 2023, 32(17-18):5974-5987.
[42]	Pham H, Phillips LK, Jones KL. Acute effects of nutritive and non-nutritive sweeteners on postprandial blood pressure[J]. Nutrients, 2019, 11(8):1717.
[43]	冯耀辉, 施阳. 电针治疗老年餐后低血压30例[J]. 环球中医药, 2018, 11(07):1098-1100.
[44]	陈洪艳, 李海燕, 张然, 等. 腹带干预对老年患者餐后低血压的预防作用[J]. 武警医学, 2023, 34(5):377-383.
[45]	Wang B, Zhao J, Zhan Q, et al. Acarbose for postprandial hypotension with glucose metabolism disorders: a systematic review and meta-analysis[J]. Front Cardiovasc Med, 2021, 8:663635.
[46]	Dieffenbach SS, Shoval HA. Treatment of postprandial hypotension with acarbose in an adult with cervical spinal cord injury: a case report[J]. Spinal Cord Ser Cases, 2023, 9(1):56. doi: 10.1038/s41394-023-00613-2 pmid: 38110351
[47]	Farrehi C, Pazzi C, Stillman M. A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose[J]. Spinal Cord Ser Cases, 2019, 5:75. doi: 10.1038/s41394-019-0220-x pmid: 31632733
[48]	Zhang J, Guo L. Effectiveness of acarbose in treating elderly patients with diabetes with postprandial hypotension[J]. J Investig Med, 2017, 65(4):772-783.
[49]	Pham H, Trahair L, Phillips L, et al. A randomized, crossover study of the acute effects of acarbose and gastric distension, alone and combined, on postprandial blood pressure in healthy older adults[J]. BMC Geriatr, 2019, 19(1):241. doi: 10.1186/s12877-019-1251-7 pmid: 31470806
[50]	Borg MJ, Rayner CK, Jones KL, et al. Gastrointestinal mechanisms underlying the cardiovascular effect of metformin[J]. Pharmaceuticals (Basel), 2020, 13(11):410.
[51]	Borg MJ, Jones KL, Sun Z, et al. Metformin attenuates the postprandial fall in blood pressure in type 2 diabetes[J]. Diabetes Obes Metab, 2019, 21(5):1251-1254. doi: 10.1111/dom.13632 pmid: 30615231
[52]	Jones KL, Rigda RS, Buttfield MDM, et al. Effects of lixisenatide on postprandial blood pressure, gastric emptying and glycaemia in healthy people and people with type 2 diabetes[J]. Diabetes Obes Metab, 2019, 21(5):1158-1167. doi: 10.1111/dom.13633 pmid: 30623563
[53]	Thazhath SS, Marathe CS, Wu T, et al. Acute effects of the glucagon-like peptide-1 receptor agonist, exenatide, on blood pressure and heart rate responses to intraduodenal glucose infusion in type 2 diabetes[J]. Diab Vasc Dis Res, 2017, 14(1):59-63.
[54]	Kraaijenhof J, Muskiet MHA, Tonneijck L, et al. Effects of dipeptidyl peptidase-4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: a secondary analysis of an 8-week, randomized, controlled, double-blind trial[J]. Diabetes Obes Metab, 2020, 22(10):1847-1856.
[55]	Borg MJ, Xie C, Rayner CK, et al. Potential for gut peptide-based therapy in postprandial hypotension[J]. Nutrients, 2021, 13(8):2826.
[56]	Furukawa K, Suzuki T, Ishiguro H, et al. Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus[J]. Endocr J, 2020, 67(6):585-592. doi: 10.1507/endocrj.EJ19-0370 pmid: 32115439
[57]	Hermush V, Beloy M, Liobeb S, et al. Orthostatic and postprandial hypotension in the elderly in the geriatric wing[J]. Harefuah, 2020, 159(5):334-338. pmid: 32431122
[58]	陈春莲. 不同服药时间对老年高血压患者餐后低血压(PPH)的影响[J]. 当代医学, 2021, 27(11):175-176.

药物	作用
α-葡萄糖苷酶抑制药（阿卡波糖^[45]、伏格列波糖）	竞争性抑制小肠黏膜上皮的蔗糖酶和葡萄糖淀粉酶，延缓碳水化合物消化吸收；阿卡波糖可用于颈脊髓损伤患者合并PPH^[46-47]；改善老年T2DM患者合并PPH的餐后血压波动^[48]；治疗PPH机制可能为通过减少餐后胃肠道血流灌注^[49]
二甲双胍	减缓肠道葡萄糖的吸收并增加去甲肾上腺素的分泌^[50]；可用于T2DM合并PPH患者，不仅可减轻收缩压下降，还增加血浆GLP-1浓度并减缓胃排空^[51]
GLP-1（艾塞那肽、利司那肽^[52]）	减缓胃排空并促进胰岛素分泌；增加餐后平均动脉血压和心率^[53]；减少肠系膜上动脉血流增加
DPP-4抑制剂	有效提高血浆GLP-1水平，利格列汀不会影响空腹血压，且可减弱餐后收缩压的下降^[54]
瓜尔胶、咖啡因、奥曲肽、GIP拮抗剂^[55]	通过减少内脏血流也可改善餐后血压下降；咖啡因可以预防PPH相关的晕厥^[56]
去甲肾上腺素前体（DL-DOPS）	在外周和中枢神经系统转化为去甲肾上腺素，提高交感神经活性