Postprandial Hypotension: Symptoms, Causes and Treatment

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In people with postprandial hypotension, the simple act of standing up after eating a meal can produce a dramatic drop in blood pressure, leading to significant symptoms. 

“Postprandial” means “after a meal.” A drop in blood pressure after eating is most commonly seen in elderly people. Up to one in three older adults will have some degree of postprandial hypotension, though for most of these the condition is mild.

 

Postprandial hypotension is one particular form of orthostatic hypotension (a drop in blood pressure when standing up). Orthostatic hypotension of all kinds is more likely to affect people with high blood pressure, or with certain conditions that impair the the autonomic nervous system such as Parkinson's disease and diabetes.

Symptoms Of Postprandial Hypotension

People who have postprandial hypotension will often notice lightheadednessdizziness, weakness or even syncope (loss of consciousness) when they stand up within 30 or 60 minutes after eating a meal. Symptoms tend to be more severe after eating a large meal, a meal that includes a lot of carbohydrates, or if alcohol is consumed during or prior to eating. These symptoms usually resolve within 90 minutes or so after finishing the meal.

What Causes Postprandial Hypotension?

While the cause of postprandial hypotension is not completely understood, it is thought to be related to the pooling of blood in the abdominal organs during the process of digestion.

Because of this blood pooling, the amount of blood available to the general circulation drops, causing the blood pressure to fall when standing.

Some amount of blood accumulation in the abdominal organs after a meal is normal, since digesting food requires an increase in blood flow. In people with postprandial hypotension, however, it is thought that this pooling of blood in the gut is exaggerated, or that the normal reflex that constricts the blood vessels in the legs (to compensate for the abdominal blood pooling) is diminished.

Eating high-carbohydrate meals appears to worsen postprandial hypotension. This observation has led some investigators to theorize that, in people with postprandial hypotension, insulin or other blood chemicals that are released in response to a high-carb meal may cause excessive dilation of the abdominal blood vessels.

To some extent, aging itself is accompanied by an increase in the abdominal blood pooling that normally occurs after a meal. Most older people never develop symptoms from such increased blood pooling — but people who do have significant symptoms from postprandial hypotension tend to be elderly.

Treating Postprandial Hypotension

While there is no specific treatment to eliminate postprandial hypotension, symptoms can be controlled adequately in the large majority of people who have this condition.

Treating the symptoms of postprandial hypotension involves four elements:

  • Eat smaller, more frequent meals. Eating large meals tends to exaggerate abdominal blood pooling. Smaller meals mean less blood pooling.
  • Avoid high-carbohydrate meals.
  • Avoid alcohol. Alcohol relaxes blood vessels and tends to prevent the constriction of blood vessels in the legs that would normally compensate for abdominal blood pooling.
  • Stay seated — or, if symptoms are severe, lie down — for 30 to 60 minutes after eating. The abdominal blood pooling tends to dissipate within an hour or so after a meal.

If these measures are insufficient, other therapies commonly used to treat orthostatic hypotension are often helpful. For example, taking nonsteroidal anti-inflammatory drugs (NSAIDs) prior to a meal can cause cause salt to be retained, thereby increasing blood volume. In addition, caffeine can cause blood vessels to constrict and may reduce symptoms. Guar gum may also improve symptoms, possibly by slowing the emptying of the stomach after a meal. Getting plenty of exercise between meals — such as walking — can improve vascular tone, and diminish symptoms of postprandial hypotension.

It has been found that, in people with postprandial hypotension who also have diastolic heart failure being treated with diuretics, withdrawing the diuretics may dramatically improve symptoms.

If symptoms are severe and cannot be controlled by other measures, subcutaneous injections of octreotide (a drug that behaves like somatostatin, a hormone produced by the pancreas) before a meal may help reduce the amount of blood flowing to the intestine. However, this treatment is quite expensive, and can cause significant side effects.

Sources:

Jansen RW, Lipsitz LA. Postprandial Hypotension: Epidemiology, Pathophysiology, and Clinical Management. Ann Intern Med 1995; 122:286.

Jones KL, MacIntosh C, Su YC, et al. Guar Gum Reduces Postprandial Hypotension in Older People. J Am Geriatr Soc 2001; 49:162.

Mills PB, Fung CK, Travlos A, Krassioukov A. Nonpharmacologic Management of Orthostatic Hypotension: a Systematic Review. Arch Phys Med Rehabil 2015; 96:366.

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