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Heart Disease (Expert Forum)
Postprandial hypotension
Answered by
Cleveland - OH
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Postprandial hypotension
by Uff Da, Sep 01, 2006 12:00AM
Background: Female age 65, high cholesterol under control with niacin, no known heart disease, family history of stroke in early 70s.
My home readings show I apparently have postprandial hypotension. My only symptom is getting extremely sleepy and lethargic after meals, especially when systolic goes below 110. On rare occasions I’ve had PPH SBP readings in the 90s and diastolics in the 50s. Typical drop of SBP is 20-30 points from before a meal to 30-60 minutes after, though it has been as much as 50+ points.
In a recent ambulatory BP test my 24-hour average SBP was 138, with a daytime high of 175 and lows of 110 at night and during a day time nap. Diastolic never reached 90. This seems typical of home readings. My doctor prescribed 5 mg Lisinopril, thinking that anything more would likely bring my systolic lows too low.
I’ve read the research which concluded that “These findings indicate that elderly hypertensive patients with marked PPH should be considered to have advanced cerebrovascular damage even in the absence of abnormal neurological findings.”
How might a person’s care differ if the doctor does make that assumption than if he does not?
Would the drops in pressure I indicated above be considered “marked PPH”?
What are the implications if I do happen to have advanced cerebrovascular damage? What is the likely cause? How might it change risk?
I’ve read the recommendations that a person with PPH should eat a high glycemic diet and eat frequent small meals. Do you have any other general suggestions for a person with PPH?
My home readings show I apparently have postprandial hypotension. My only symptom is getting extremely sleepy and lethargic after meals, especially when systolic goes below 110. On rare occasions I’ve had PPH SBP readings in the 90s and diastolics in the 50s. Typical drop of SBP is 20-30 points from before a meal to 30-60 minutes after, though it has been as much as 50+ points.
In a recent ambulatory BP test my 24-hour average SBP was 138, with a daytime high of 175 and lows of 110 at night and during a day time nap. Diastolic never reached 90. This seems typical of home readings. My doctor prescribed 5 mg Lisinopril, thinking that anything more would likely bring my systolic lows too low.
I’ve read the research which concluded that “These findings indicate that elderly hypertensive patients with marked PPH should be considered to have advanced cerebrovascular damage even in the absence of abnormal neurological findings.”
How might a person’s care differ if the doctor does make that assumption than if he does not?
Would the drops in pressure I indicated above be considered “marked PPH”?
What are the implications if I do happen to have advanced cerebrovascular damage? What is the likely cause? How might it change risk?
I’ve read the recommendations that a person with PPH should eat a high glycemic diet and eat frequent small meals. Do you have any other general suggestions for a person with PPH?
Doctor's Answer
by Cleveland Clinic, Sep 01, 2006 12:00AM
, Sep 01, 2006 12:00AM
Uffda,
Postprandial hypotension is characterized by a drop in blood pressure after meals. Normally the intestines require a large amount of blood to help with digestion. When blood flows to the intestines after a meal, the heart rate increases and the rest of the blood blood vessels in the body tighten down to maintain blood pressure. However, in some, such mechanisms may be not be enough to compensate and as a result blood pressure decreases.
Certain disorders, especially those that can effect the autonomic nervous system can cause the condition, it is also more pronouced in those with hypertension. In some the drops in blood pressure are severe enough to cause blackouts.
There is no magical remedy and the most effective treatments tend to be behavioral such as avoiding taking blood pressure medicine before meals and lying down or walking after meals. Also, smaller
meals and low carb meals may help.
Some say caffein or NSAIDS may also help, but this is debateable. You should probably be evaluated by a good internist for other conditions such as diabetes or cerebrovascular disease that can contribute or cause symptoms. Usually a good history and physical and limited testing can rule out any of these causes.
My definition of marked would be severe symptoms associated with the blood pressure drop, but I do not know if there is a true definition.
good luck
Postprandial hypotension is characterized by a drop in blood pressure after meals. Normally the intestines require a large amount of blood to help with digestion. When blood flows to the intestines after a meal, the heart rate increases and the rest of the blood blood vessels in the body tighten down to maintain blood pressure. However, in some, such mechanisms may be not be enough to compensate and as a result blood pressure decreases.
Certain disorders, especially those that can effect the autonomic nervous system can cause the condition, it is also more pronouced in those with hypertension. In some the drops in blood pressure are severe enough to cause blackouts.
There is no magical remedy and the most effective treatments tend to be behavioral such as avoiding taking blood pressure medicine before meals and lying down or walking after meals. Also, smaller
meals and low carb meals may help.
Some say caffein or NSAIDS may also help, but this is debateable. You should probably be evaluated by a good internist for other conditions such as diabetes or cerebrovascular disease that can contribute or cause symptoms. Usually a good history and physical and limited testing can rule out any of these causes.
My definition of marked would be severe symptoms associated with the blood pressure drop, but I do not know if there is a true definition.
good luck
I’ve read the recommendations that a person with PPH should eat a LOW glycemic diet and eat frequent small meals. Do you have any other general suggestions for a person with PPH?