Postprandial Hypotension: Simple Treatment But Difficulties With the Diagnosis

Extract

Over the past two decades, a growing amount of work on postprandial hypotension has been published. Postprandial hypotension has now been recognized as a very common clinically relevant disorder in elderly persons (1,2).

In healthy elderly persons, meal-induced decreases in blood pressure are common but mostly asymptomatic (2). Elderly persons with hypertension have an increased frequency of postprandial hypotension. Patients with heart failure, syncope, or Parkinson's disease; patients on dialysis; and persons with autonomic dysfunction tend to have worse postprandial hypotension (2–5). In these patients, the prevalence of postprandial hypotension ranges from 40% to more than 80%. Postprandial hypotension was also highly prevalent in very old depressed patients. Treatment with nortriptyline or paroxetine did not affect postprandial blood pressure responses and symptoms (6). In hospital and institutionalized populations, the prevalence of postprandial hypotension in elderly persons is higher than that in the community because of the higher frequency of comorbid conditions and diseases and the increased number of medications, which all may have effects on blood pressure regulation. Nearly all elderly nursing home residents experience postprandial hypotension (7). In almost 40% of these residents, systolic blood pressure decreases more than 20 mmHg within 75 minutes of eating a meal (7,8).