Circulation, Vol 87, 391-400, Copyright © 1993 by American Heart Association
LA Lipsitz, SM Ryan, JA Parker, R Freeman, JY Wei and AL Goldberger
BACKGROUND. Although postprandial hypotension is a common cause of falls
and syncope in elderly persons and in patients with autonomic
insufficiency, the pathophysiology of this disorder remains unknown.
METHODS AND RESULTS. We examined the hemodynamic, splanchnic blood pool,
plasma norepinephrine (NE), and heart rate (HR) power spectra responses to
a standardized 400-kcal mixed meal in 11 healthy young (age, 26 +/- 5
years) and nine healthy elderly (age, 80 +/- 5 years) subjects and 10
dysautonomic patients with symptomatic postprandial hypotension (age, 65
+/- 16 years). Cardiac and splanchnic blood pools were determined
noninvasively by radionuclide scans, and forearm vascular resistance was
determined using venous occlusion plethysmography. In healthy young and old
subjects, splanchnic blood volume increased, but supine blood pressure
remained unchanged after the meal. In both groups, HR increased and
systemic vascular resistance remained stable. Forearm vascular resistance
and cardiac index increased after the meal in elderly subjects, whereas
these responses were highly variable and of smaller magnitude in the young.
Young subjects demonstrated postprandial increases in low-frequency HR
spectral power, representing cardiac sympatho-excitation, but plasma NE
remained unchanged. In elderly subjects, plasma NE increased after the meal
but without changes in the HR power spectrum. Patients with dysautonomia
had a large postprandial decline in blood pressure associated with no
change in forearm vascular resistance, a fall in systemic vascular
resistance, and reduction in left ventricular end diastolic volume index.
HR increased in these patients but without changes in plasma NE or the HR
power spectrum. CONCLUSIONS. 1) In healthy elderly subjects, the
maintenance of blood pressure homeostasis after food ingestion is
associated with an increase in HR, forearm vascular resistance, cardiac
index, and plasma NE. In both young and old, systemic vascular resistance
is maintained. 2) Dysautonomic patients with postprandial hypotension fail
to maintain systemic vascular resistance after a meal. This impairment in
vascular response to meal ingestion may underlie the development of
postprandial hypotension. 3) The measurement of mean HR or plasma NE does
not adequately characterize autonomic cardiac control. Power spectral
analysis suggests an impairment in the postprandial autonomic modulation of
HR in healthy elderly and dysautonomic subjects, possibly predisposing to
hypotension when vascular compensation is inadequate.
ARTICLES
Hemodynamic and autonomic nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension
Hebrew Rehabilitation Center for Aged, Boston, MA 02131.
This article has been cited by other articles:
 |
|
 |
|
  R. Freeman Neurogenic Orthostatic Hypotension N. Engl. J. Med., February 7, 2008; 358(6): 615 - 624. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gentilcore, T. Hausken, J. H Meyer, I. M Chapman, M. Horowitz, and K. L Jones Effects of intraduodenal glucose, fat, and protein on blood pressure, heart rate, and splanchnic blood flow in healthy older subjects Am. J. Clinical Nutrition, January 1, 2008; 87(1): 156 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gentilcore, T. J. Little, C. Feinle-Bisset, M. Samsom, A. J. P. M. Smout, M. Horowitz, and K. L. Jones Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects Am J Physiol Gastrointest Liver Physiol, October 1, 2007; 293(4): G692 - G698. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. M. Vloet, R. E. Pel-Little, P. A. F. Jansen, and R. W. M. M. Jansen High Prevalence of Postprandial and Orthostatic Hypotension Among Geriatric Patients Admitted to Dutch Hospitals J. Gerontol. A Biol. Sci. Med. Sci., October 1, 2005; 60(10): 1271 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. W. Parry, I. N. Steen, M. Baptist, and R. A. Kenny Amnesia for Loss of Consciousness in Carotid Sinus Syndrome: Implications for Presentation With Falls J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1840 - 1843. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Gentilcore, R. Visvanathan, A. Russo, R. Chaikomin, J. E. Stevens, J. M. Wishart, A. Tonkin, M. Horowitz, and K. L. Jones Role of nitric oxide mechanisms in gastric emptying of, and the blood pressure and glycemic responses to, oral glucose in healthy older subjects Am J Physiol Gastrointest Liver Physiol, June 1, 2005; 288(6): G1227 - G1232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C. M. Vloet, R. Smits, and R. W. M. M. Jansen The Effect of Meals at Different Mealtimes on Blood Pressure and Symptoms in Geriatric Patients With Postprandial Hypotension J. Gerontol. A Biol. Sci. Med. Sci., November 1, 2003; 58(11): M1031 - 1035. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. O'Donovan, C. Feinle, A. Tonkin, M. Horowitz, and K. L. Jones Postprandial hypotension in response to duodenal glucose delivery in healthy older subjects J. Physiol., April 15, 2002; 540(2): 673 - 679. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. C.M. Vloet, D. J. Mehagnoul-Schipper, W. H.L. Hoefnagels, and R. W.M.M. Jansen The Influence of Low-, Normal-, and High-Carbohydrate Meals on Blood Pressure in Elderly Patients With Postprandial Hypotension J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2001; 56(12): M744 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Akehi, H. Yoshimatsu, M. Kurokawa, T. Sakata, H. Eto, S. Ito, and J. Ono VLCD-Induced Weight Loss Improves Heart Rate Variability in Moderately Obese Japanese Experimental Biology and Medicine, May 1, 2001; 226(5): 440 - 445. [Abstract] [Full Text]
|
|
|
|
 |
|
 W Arthur and G C Kaye Important points in the clinical evaluation of patients with syncope Postgrad. Med. J., February 1, 2001; 77(904): 99 - 102. [Full Text]
|
|
|
|
|
|
J. Belmin, M. Abderrhamane, S. Medjahed, J. Sibony-Prat, A. Bruhat, N. Bojic, and T. Marquet Variability of Blood Pressure Response to Orthostatism and Reproducibility of the Diagnosis of Orthostatic Hypotension in Elderly Subjects J. Gerontol. A Biol. Sci. Med. Sci., November 1, 2000; 55(11): 667M - 671. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. S. Maurer, W. Karmally, H. Rivadeneira, M. K. Parides, and D. M. Bloomfield Upright Posture and Postprandial Hypotension in Elderly Persons Ann Intern Med, October 3, 2000; 133(7): 533 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Puisieux, H. Bulckaen, A. L. Fauchais, S. Drumez, F. Salomez-Granier, and P. Dewailly Ambulatory Blood Pressure Monitoring and Postprandial Hypotension in Elderly Persons With Falls or Syncopes J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2000; 55(9): 535M - 540. [Abstract] [Full Text]
|
|
|
|
|
|
A. S. Oberman, M. M. Gagnon, D. K. Kiely, J. C. Nelson, and L. A. Lipsitz Autonomic and Neurohumoral Control of Postprandial Blood Pressure in Healthy Aging J. Gerontol. A Biol. Sci. Med. Sci., August 1, 2000; 55(8): 477M - 483. [Abstract] [Full Text]
|
|
|
|
 |
|
 G. Chelimsky, V. F. Hupertz, and T. C. Chelimsky Abdominal Pain as the Presenting Symptom of Autonomic Dysfunction in a Child Clinical Pediatrics, November 1, 1999; 38(12): 725 - 729. [PDF]
|
|
|
|
 |
|
 D. J. W. van Kraaij, R. W. M. M. Jansen, L. H. R. Bouwels, and W. H. L. Hoefnagels Furosemide Withdrawal Improves Postprandial Hypotension in Elderly Patients With Heart Failure and Preserved Left Ventricular Systolic Function Arch Intern Med, July 26, 1999; 159(14): 1599 - 1605. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. Baliga, S. D. Rosen, P. G. Camici, and J. S. Kooner Regional Myocardial Blood Flow Redistribution as a Cause of Postprandial Angina Pectoris Circulation, March 31, 1998; 97(12): 1144 - 1149. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Biston, E. Van Cauter, G. Ofek, P. Linkowski, K. S. Polonsky, and J.-P. Degaute Diurnal Variations in Cardiovascular Function and Glucose Regulation in Normotensive Humans Hypertension, November 1, 1996; 28(5): 863 - 871. [Abstract] [Full Text]
|
|
|
|
 |
|
 T.G. Robinson and J.F. Potter Postprandial and Orthostatic Cardiovascular Changes After Acute Stroke Stroke, October 1, 1995; 26(10): 1811 - 1816. [Abstract] [Full Text]
|
|
|
|
|
|
L. A. Lipsitz, C. M. Connelly, M. Kelley-Gagnon, D. K. Kiely, and R. J. Morin Effects of Chronic Estrogen Replacement Therapy on Beat-to-Beat Blood Pressure Dynamics in Healthy Postmenopausal Women Hypertension, October 1, 1995; 26(4): 711 - 715. [Abstract] [Full Text]
|
|
|
|
|
|
R. W. M. M. Jansen, C. M. Connelly, M. M. Kelley-Gagnon, J. A. Parker, and L. A. Lipsitz Postprandial Hypotension in Elderly Patients With Unexplained Syncope Arch Intern Med, May 8, 1995; 155(9): 945 - 952. [Abstract] [PDF]
|
|
|
|
|
|
D. O'Donovan, C. Feinle, A. Tonkin, M. Horowitz, and K. L. Jones Postprandial hypotension in response to duodenal glucose delivery in healthy older subjects J. Physiol., April 15, 2002; 540(2): 673 - 679. [Abstract] [Full Text] [PDF]
|
|