Abstract
Postprandial hypotension (PPH) is under-recognised, but common, particularly in the elderly, and is of clear clinical importance due to both the independent association between PPH and an increase in mortality and lack of effective management for this condition. Following health concerns surrounding excessive consumption of sugar, there has been a trend in the use of low- or non-nutritive sweeteners as an alternative. Due to the lack of literature in this area, we conducted a systematic search to identify studies relevant to the effects of different types of sweeteners on postprandial blood pressure (BP). The BP response to ingestion of sweeteners is generally unaffected in healthy young subjects, however in elderly subjects, glucose induces the greatest decrease in postprandial BP, while the response to sucrose is less pronounced. The limited studies investigating other nutritive and non-nutritive sweeteners have demonstrated minimal or no effect on postprandial BP. Dietary modification by replacing high nutritive sweeteners (glucose, fructose, and sucrose) with low nutritive (d-xylose, xylitol, erythritol, maltose, maltodextrin, and tagatose) and non-nutritive sweeteners may be a simple and effective management strategy for PPH.
Highlights
The consumption of nutritive sweeteners has dramatically increased worldwide due to increasing urbanisation and beverage promotion [1]
The effects of both nutritive and non-nutritive sweeteners on cardiovascular risk factors, including blood pressure (BP), have been extensively investigated, less is known about their specific effects in the postprandial state
Postprandial hypotension (PPH) is associated with an increased incidence of falls, syncope, angina and transient ischaemic attacks, in older people and patients with autonomic failure that is frequently secondary to diabetes mellitus and Parkinson’s disease (PD)
Summary
The consumption of nutritive sweeteners has dramatically increased worldwide due to increasing urbanisation and beverage promotion [1]. There has been a long history of debate as to the detrimental health effects of sucrose, glucose, and more recently, fructose, when consumed in excess. The effects of both nutritive and non-nutritive sweeteners on cardiovascular risk factors, including blood pressure (BP), have been extensively investigated, less is known about their specific effects in the postprandial state. In a cohort study of 401 elderly ambulatory hypertensive subjects, 292 (72.8%) were found to have PPH, and over a 4 year period, 34 died from cardiovascular disease; the post-breakfast BP fall was the strongest predictor of mortality in this cohort [8]. In a 29-month prospective study of 499 nursing home residents, the maximum
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