Abstract
BackgroundPostprandial hypotension (PPH) occurs frequently in the elderly and patients with type 2 diabetes, and lacks a satisfactory treatment. Gastric distension and the α-glucosidase inhibitor, acarbose, may attenuate the postprandial fall in blood pressure (BP) by complementary mechanisms. We aimed to determine whether gastric distension and acarbose have additive effects to attenuate the fall in BP induced by oral sucrose.MethodsTen healthy older adults (74.0 ± 1.4 yr) had measurements of BP and superior mesenteric artery (SMA) blood flow for 120 min after receiving either (i) the ‘study drink’ of 100 g sucrose in 300 mL of water (control treatment), (ii) a 300 mL water ‘preload’ 15 min before the ‘study drink’ (distension treatment), (iii) 100 mg acarbose dissolved in the ‘study drink’ (acarbose treatment) or (iv) a 300 ml water ‘preload’ 15 min before 100 mg acarbose dissolved in the ‘study drink’ (acarbose and distension treatment).ResultsThe area under the curve (AUC)0–120min for mean arterial pressure (MAP) was greater (P = 0.005) and the maximum fall in MAP was less (P = 0.006) during treatments with acarbose. Gastric distension did not affect the MAP-AUC0–120min response to acarbose (P = 0.44) and there was no effect of gastric distension alone (P = 0.68). Both acarbose treatments attenuated the rise in SMA blood flow (P = 0.003), whereas gastric distension had no effect.ConclusionsIn healthy older adults, acarbose (100 mg), but not gastric distension, attenuates the fall in BP and rise in SMA blood flow after oral sucrose. The observations support the use of acarbose, but not gastric distension, to attenuate a postprandial fall in BP.Trial registrationThe study was retrospectively registered at (ACTRN12618000152224) on February 02nd 2018.
Highlights
Postprandial hypotension (PPH) occurs frequently in the elderly and patients with type 2 diabetes, and lacks a satisfactory treatment
We have shown in healthy older adults and people with Type 2 diabetes (T2DM) that the magnitude of the postprandial fall in blood pressure (BP) is greater when the rate of gastric emptying [6], or direct small intestinal nutrient delivery [7, 8], is relatively more rapid
We reported previously that acarbose (100 mg) attenuated the fall in systolic BP induced by oral sucrose in healthy older adults, an effect associated temporally with slowing of gastric emptying and stimulation of glucagon-like peptide-1 (GLP-1) [17]
Summary
Postprandial hypotension (PPH) occurs frequently in the elderly and patients with type 2 diabetes, and lacks a satisfactory treatment. We have shown in healthy older adults and people with T2DM that the magnitude of the postprandial fall in BP is greater when the rate of gastric emptying [6], or direct small intestinal nutrient delivery [7, 8], is relatively more rapid. Drinking water with a meal has been reported to attenuate the postprandial fall in BP in healthy older adults [10, 11], as well as in patients with autonomic failure [10,11,12], probably primarily by inducing gastric distension. The pressor response to water may be greater in patients with autonomic failure [11]
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