Fall In Systolic Blood Pressure Research Articles

Clevidipine: a review of its use in the management of acute hypertension.

Clevidipine: a review of its use in the management of acute hypertension.

Analysing Recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000–2007: A Population Modelling Study

Coronary heart disease (CHD) mortality in England fell by approximately 6% every year between 2000 and 2007. However, rates fell differentially between social groups with inequalities actually widening. We sought to describe the extent to which this reduction in CHD mortality was attributable to changes in either levels of risk factors or treatment uptake, both across and within socioeconomic groups. A widely used and replicated epidemiological model was used to synthesise estimates stratified by age, gender, and area deprivation quintiles for the English population aged 25 and older between 2000 and 2007. Mortality rates fell, with approximately 38,000 fewer CHD deaths in 2007. The model explained about 86% (95% uncertainty interval: 65%-107%) of this mortality fall. Decreases in major cardiovascular risk factors contributed approximately 34% (21%-47%) to the overall decline in CHD mortality: ranging from about 44% (31%-61%) in the most deprived to 29% (16%-42%) in the most affluent quintile. The biggest contribution came from a substantial fall in systolic blood pressure in the population not on hypertension medication (29%; 18%-40%); more so in deprived (37%) than in affluent (25%) areas. Other risk factor contributions were relatively modest across all social groups: total cholesterol (6%), smoking (3%), and physical activity (2%). Furthermore, these benefits were partly negated by mortality increases attributable to rises in body mass index and diabetes (-9%; -17% to -3%), particularly in more deprived quintiles. Treatments accounted for approximately 52% (40%-70%) of the mortality decline, equitably distributed across all social groups. Lipid reduction (14%), chronic angina treatment (13%), and secondary prevention (11%) made the largest medical contributions. The model suggests that approximately half the recent CHD mortality fall in England was attributable to improved treatment uptake. This benefit occurred evenly across all social groups. However, opposing trends in major risk factors meant that their net contribution amounted to just over a third of the CHD deaths averted; these also varied substantially by socioeconomic group. Powerful and equitable evidence-based population-wide policy interventions exist; these should now be urgently implemented to effectively tackle persistent inequalities.

Effects of Pomegranate Juice Supplementation on Pulse Wave Velocity and Blood Pressure in Healthy Young and Middle-aged Men and Women

Pomegranate juice may improve cardiovascular risk because of its content of antioxidant polyphenols. We conducted a randomized placebo-controlled parallel study to examine the effect of pomegranate juice on pulse wave velocity (PWV), blood pressure (BP) and plasma antioxidant status (ferric reducing power; FRAP) in 51 healthy adults (30-50years). Participants consumed 330ml/day of pomegranate juice or control drink for fourweeks. Measurements were made at baseline and at fourweeks. There was no effect of the intervention on PWV (P = 0.694) and plasma FRAP (P = 0.700). However, there was a significant fall in systolic blood pressure (-3.14 mmHg, P < 0.001), diastolic blood pressure (-2.33 mmHg P < 0.001) and mean arterial pressure (-2.60 mmHg, P < 0.001). Change in weight was similar in the two groups over the intervention period (P = 0.379). The fall in BP was not paralleled by changes in concentration of serum angiotensin converting enzyme. We conclude that pomegranate juice supplementation has benefits for BP in the short term, but has no effect on PWV. The mechanism for the effect is uncertain.

Cystatin C Levels in Patients With Dipper and Nondipper Hypertension

ObjectiveSubjects with nondipper hypertension carry a higher risk of cardiovascular events than their normotensive counterparts. The present study was designed to investigate cystatin C levels in patients with dipper and...

The effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure

Blunted nighttime blood pressure dipping is an established cardiovascular risk factor. This study examined the effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure. The sample consisted of 122 blue- and white collar workers (men=72, women=50). The Job Content Questionnaire was used to measure job psychological demands, job control, and social support. The ratio of job demands to job control was used to assess job strain. Nighttime blood pressure dipping was evaluated from 24-hour ambulatory blood pressure monitoring performed on three workdays. Men with high job strain had a 5.4 mm Hg higher sleep systolic blood pressure (P=0.03) and 3.5 mm Hg higher sleep pulse pressure (P=0.02) compared to men with low job strain. Men with high job strain had a smaller fall in systolic blood pressure and pulse pressure from awake to sleep state than those with low job strain (P<0.05). Hierarchical analyses showed that job strain was an independent determinant of systolic blood pressure dipping (P=0.03) among men after adjusting for ethnicity, body mass index, anxiety and depression symptoms, current smoking status, and alcohol consumption. Further exploratory analyses indicated that job control was the salient component of job strain associated with blood pressure dipping (P=0.03). High job strain is associated with a blunting of the normal diurnal variation in blood pressure and pulse pressure, which may contribute to the relationship between job strain and cardiovascular disease.

Factors related to orthostatic hypotension in Parkinson's disease

IntroductionOrthostatic hypotension (OH), a frequent feature of Parkinson's disease (PD) can contribute to falls and is usually related to the disease itself and/or to drugs. ObjectivesTo explore factors related to OH and to assess the concordance between abnormal blood pressure (BP) fall after standing and the presence of orthostatic symptoms. MethodsNon-demented, non-operated idiopathic PD out-patients were questioned about the presence of orthostatic symptoms. Afterward, BP was measured 5-min after lying down and for 3-min after standing up. OH was defined as systolic and/or diastolic BP fall ≥20 and/or 10mmHg after standing. Patients were further evaluated by the Unified PD Rating Scale (UPDRS) and their medications were recorded. Results103 patients were included in this study (mean age=66±1 years, mean disease duration=9±1 years; mean UPDRS II+III in ON-state=37±2 points). Forty-one subjects (40%) reported the presence of orthostatic symptoms during the previous week and 38 (37%) had OH according to manometric definition. Independent factors related to OH, as assessed by logistic regression were age >68 years (OR, 95% CI=3.61, 1.31–9.95), polypharmacy (defined as intake of >5 medications, OR=3.59, 1.33–9.69), amantadine (7.45, 1.91–29.07) or diuretics (5.48, 1.10–54.76), whereas the consumption of entacapone was protective (0.20, 0.05–0.76). The agreement between abnormal BP fall and presence of orthostatic symptoms was poor (kappa=0.12±0.1, p=0.23). ConclusionOH was significantly related to older age, polypharmacy and amantadine or diuretics intake, while entacapone exposure appeared to reduce the risk of OH. Low concordance between OH and orthostatic symptoms was observed.

Comparative Evaluation Of Gabapentin, Clonidine And Combination Of Both The Drugs To Attenuate The Pressor Response To Direct Laryngoscopy And Intubation.

Background: The aim of our study was to compare the relative effectiveness of gabapentin and clonidine in attenuation of pressor response to direct laryngoscopy and intubation, and to evaluate the synergistic effect of combination of both drugs.Materials and methods: 120 patients of either sex of age between 20-60 years of American Society of Anaesthesiologist (ASA) grade I and II admitted 24 hours before elective surgery requiring general anaesthesia (GA) were included in the study. Patients were randomly allocated into four groups of 30 patients each: patients received oral 800 mg of gabapentin (group A), 300 μg of clonidine (group B), 400 mg of gabapentin and 150μg of clonidine (group C) and placebo (group D); 60 minutes (min.) prior to induction of anaesthesia. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were measured before induction, intubation and at 0,1,3,5 and 10 minutes after intubation.Results: Analysis revealed that there was significant rise in HR at 0 minute in all the groups (p<0.05) except in group B. It remained to significant levels in group C and D up to 10 minutes (p<0.001 and p<0.01) but in group A it returned to insignificant level at 3 minutes. There was statistically highly significant rise in SBP, DBP and MAP (p<0.001,p<0.001 and p<0.01) in all the groups except in group A. In group A statistically significant (p<0.001) fall in SBP, DBP and MAP continued up to 10 minutes.Conclusion: Given 60 minutes before induction of GA, oral gabapentin and clonidine in the dose of 800mg and 300μg attenuate the pressor response but gabapentin blunts the increase in arterial blood pressure better than clonidine. The combination of these two drugs in the studied dosage was not effective in attenuating the pressor response to laryngoscopy and intubation.

Effect of intravenous infusion of dexmedetomidine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis

Background:Dexmedetomidine, an α2 agonist, when used as an adjuvant in general anaesthesia attenuates stress response to various noxious stimuli, maintains perioperative haemodynamic stability and provides sedation without significant respiratory depression postoperatively.Methods:Sixty patients were randomly divided into two groups of 30 each. In group A, fentanyl 2 μg/kg and in group B dexmedetomidine were given intravenously as loading dose of 1 μg/kg over 10 min prior to induction. After induction with thiopentone, in group B, dexmedetomidine was given as infusion at a dose of 0.2–0.8 μg/kg. Sevoflurane was used as inhalation agent in both groups. Haemodynamic variables and entropy (response entropy and state entropy) were recorded continuously. Postoperative sedation and recovery were assessed by sedation score and modified Aldrete's score, respectively.Results:Dexmedetomidine significantly attenuates stress response at intubation with lesser increase in heart rate (10% vs. 17%), systolic blood pressure (6% vs. 23%) and diastolic blood pressure (7% vs. 20%) as compared to the control group (P<0.05). Intraoperatively, an average of 8% fall in systolic blood pressure and 8.16% fall in diastolic pressure in the test group as compared to 3.6% rise in systolic and 3.3% in diastolic pressure of the control group was observed. Postoperatively, the test group showed significant sedation at 2 h as compared to the control group (P=0.00) and recovery was better in the control group for the first 2 h post extubation.Conclusion:Dexmedetomidine attenuates various stress responses during surgery and maintains the haemodynamic stability when used as an adjuvant in general anaesthesia. Also, the sedative action of dexmedetomidine delays recovery for the first few hours post extubation.

Orthostatic hypotension among outpatients with ischemic stroke

BackgroundThe treatment of hypertension is an essential component of stroke prevention; however, the clinical management of patients with cerebrovascular disease is complicated by orthostatic hypotension (OH). The primary objectives were to: determine the prevalence of OH in a stroke outpatient clinic; describe categories of OH; and identify factors independently associated with the presence of OH. MethodsVeterans with stroke, cared for in a multidisciplinary stroke clinic, were included. OH was defined as a ≥20mmHg fall in systolic blood pressure (BP), a ≥10mmHg fall in diastolic BP, or a ≥10mmHg fall in systolic BP with symptoms. Multivariable logistic regression was used to identify factors associated with OH including demographics, comorbidites, stroke severity, and baseline BP. ResultsAmong 60 patients with stroke, 16 (27%) patients had OH. Among those with OH, half were hypertensive, seven were normotensive, and one was hypotensive. A history of coronary artery disease was independently associated with the presence of OH. ConclusionsOrthostatic hypotension is present in about one quarter of outpatients with stroke, and coronary artery disease appears to be a risk factor. Stroke patients should be screened for OH given that the presence of positional BP changes may alter clinical management.

Autonomic dysfunction in ischemic stroke with carotid stenosis

Impaired autonomic function is common in acute ischemic stroke. Previous limited studies have suggested that atherosclerosis may affect the distensibility of the carotid sinus and then impair the cardiovascular autonomic function. This study sought to investigate cardiovascular autonomic function in patients with ischemic stroke with carotid stenosis. Eighty-five patients with ischemic stroke (58 ones without carotid stenosis and 27 ones with carotid stenosis, average 6 months after stroke onset) and 37 elderly controls were recruited. All performed Ewing's battery autonomic function tests. From Ewing's battery of autonomic function tests, atypical, definite, or severe autonomic dysfunction was identified in 69.0% patients without carotid stenosis and 88.9% with carotid stenosis, with significant difference between the two groups, and the prevalence of autonomic dysfunction in both groups was higher than that in controls (21.6%). Patients with carotid stenosis showed impairment of all parasympathetic tests (all P < 0.05) and one of the sympathetic tests [Mean fall in systolic blood pressure (BP) on standing: P = 0.051], and those without carotid stenosis only showed impairment in two parasympathetic tests (Valsalva ratio: P = 0.014; heart rate response to deep breathing: P < 0.001) in comparison with controls. Patients with carotid stenosis had significantly more impairment than those without carotid stenosis in some autonomic parameters (Valsalva ratio: P < 0.05; mean fall in systolic BP on standing: P < 0.05). Cardiovascular autonomic function is impaired in patients with ischemic stroke, but patients with carotid stenosis show more severely impaired parasympathetic and sympathetic functions.

The relationship between 24 h ambulatory blood pressure monitoring rhythm and carotid-radial pulse wave velocity, intima media thickness in prehypertensive subjects

ObjectiveTo analyse the relationship between 24 h ABPM rhythm and crPWV, IMT in prehypertensive subjects.MethodsAccording to the blood pressure level, 286 cases were divided into two groups, namely, normotensive controls...

Effect of yogic bellows on cardiovascular autonomic reactivity.

Context:Yoga is an ancient science, which originated in India. Pranayama has been assigned a very important role in yogic system of exercises. It is known that regular practice of breathing exercises (pranayama) increases parasympathetic tone, decreases sympathetic activity, and improves cardiovascular functions. Different types of breathing exercises alter autonomic balance for good by either decrease in sympathetic or increase in parasympathetic activity. Mukh Bhastrika (yogic bellows), a type of pranayama breathing when practiced alone, has demonstrated increase in sympathetic activity and load on heart, but when practiced along with other types of pranayama has showed improved cardiac performance.Aim:The present study was conducted to evaluate the effect of long term practice of fast pranayama (Mukh Bhastrika) on autonomic balance on individuals with stable cardiac function.Settings and Design:This interventional study was conducted in the department of physiology.Materials and Methods:50 healthy male subjects of 18 - 25 years age group, fulfilling the inclusion and exclusion criteria underwent Mukh Bhastrika training for 12 weeks. Cardiovascular autonomic reactivity tests were performed before and after the training.Statistical Analysis Used:The parameters were analyzed by Student t test.Results:This study showed an increase in parasympathetic activity i.e., reduced basal heart rate, increase in valsalva ratio and deep breathing difference in heart rate; and reduction in sympathetic activity i.e., reduction in fall of systolic blood pressure on posture variation.Conclusion:It can be concluded that Mukh Bhastrika has beneficial effect on cardiac autonomic reactivity, if practiced for a longer duration.

To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure

Dipping and nondipping blood pressure (BP) patterns are associated with different levels of target organ damage and cardiovascular risk. The aim of our investigation was to determine the relationship between different BP patterns (dipping, nondipping, extreme dipping and reverse dipping type) and cardiac structure, and function in hypertensive patients. This cross-sectional study included 376 hypertensive patients. All subjects underwent 24-h ambulatory BP monitoring, and complete two-dimensional, pulsed and tissue Doppler echocardiography. Most of the parameters of the left ventricular (LV) diastolic function (E/A, e'/a', E/e') significantly and progressively deteriorated from the extreme dippers to the dippers and nondippers, and finally to the reverse dippers. In contrast, LV structural parameters (IVS, RWT, LV mass index) showed a statistically important difference only by comparing the dippers and the extreme dippers with the rest of the patients. Simultaneously, the right ventricular (RV) structural parameter (RVT, right ventricular thickness), and most RV diastolic parameters significantly and progressively worsened from the extreme dippers, over the dippers and the nondippers, to the reverse dippers. Daytime and night time systolic BP, nocturnal systolic BP fall, and the nondipping and the reverse dipping status were independently associated with LV and RV structure, as well as with diastolic function. LV and RV structure, and diastolic function were significantly more impaired with the nondippers and the reverse dippers compared with others.

Standing worsens cognitive functions in patients with neurogenic orthostatic hypotension

In previous studies, addressing the association between orthostatic hypotension and cognitive decline, patients underwent neuropsychological evaluation in sitting position, and blood pressure values and cognition were not measured concurrently. Furthermore, no studies assessed the acute effects of orthostatic hypotension on cognitive performances. The aim of our study was to evaluate the effect of a documented fall in systolic blood pressure (SBP) of at least 20 mmHg on a battery of cognitive tests in patients with neurogenic orthostatic hypotension. Ten consecutive patients with neurogenic orthostatic hypotension, normal brain imaging, and a normal Mini Mental State Examination in supine position were enrolled in the study. Patients underwent a detailed neuropsychological assessment (Brief Mental Deterioration battery and computerized tests) over two test sessions: the first while tilted to an angle able to cause a fall of at least 20 mmHg in SBP; the second while supine, after 30 min of rest. Parallel forms of the tests were presented on each testing session. Patients scored significantly worse in the visual search test, analogies test, immediate visual memory, and the measure of global cognitive functioning of Brief Mental Deterioration battery during the orthostatic challenge compared to the supine position. Orthostatic hypotension was associated with a significant worsening of cognitive performances, affecting both global cognitive functioning and specific tasks, mainly exploring executive functions. The assessment of cognitive function in patients with neurogenic orthostatic hypotension should be performed considering the body's position of the subject.

Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia

Intra-operative hypotension is a frequent occurrence during anaesthesia for hip fracture surgery in older patients with co-morbidities. We analysed retrospective data from the Brighton Hip Fracture Database to determine the intra-operative fall in systolic blood pressure, and the incidence of absolute (lowest systolic blood pressure < 90 mmHg) and relative (> 20% fall in systolic blood pressure from baseline) hypotension during general or spinal anaesthesia among 1131 non-consecutive patients with hip fracture. General anaesthesia for 489 patients (43.2%) produced a greater mean (SD) fall in systolic blood pressure than spinal anaesthesia for 578 patients (51.1%): 34.2% (13.0%) vs 29.7% (10.8%), respectively (p < 0.0001), mean difference 4.5% (95% CI 3.1-5.9%), and was associated with greater mean (SD) intra-operative fluid administration (1555 (801) ml vs 1375 (621) ml, respectively, p < 0.0001). We observed a correlation between the volume of subarachnoid hyperbaric bupivacaine 0.5% and fall in systolic blood pressure (p = 0.004): compared with patients receiving > 1.5 ml (n = 463), fewer patients receiving ≤ 1.5 ml bupivacaine 0.5% (n = 97) experienced episodes of absolute (31.1% vs 11.3%, p < 0.0001) or relative (83.9% vs 26.8%, p < 0.0001) hypotension. Both mean (SD) intravenous fluid administration (1097 ml (439) vs 1431 ml (638), p < 0.0001) and mean peri-operative fall in haemoglobin concentration (2.1 (1.8) g.dl(-1) vs 2.6 (1.7) g.dl(-1), p = 0.009) were lower in the low-dose spinal group. If these data are confirmed by other researchers, intra-operative hypotension (and consequent haemodilution secondary to reactive fluid administration) in this patient group may be reduced by the simple expedient of administering more cautious general anaesthesia, or reduced volumes of subarachnoid local anaesthetic.

O1-4.1 Explaining recent coronary heart disease mortality trends in England by socioeconomic circumstances, 2000-2007

Introduction The continuing fall in coronary heart disease mortality rates is widely celebrated. However, the impact of public policies and treatments is poorly quantified and hardly ever by socioeconomic group. Methods Using a previously validated epidemiological model we estimated the contribution of risk factor changes and evidence-based treatments to reduce CHD mortality in adults aged over 25 years between 2000 and 2007 in England, both overall and by deprivation quintiles. Results CHD mortality rates fell by 35% (219 to 142 deaths per 100 000), resulting in 38 070 fewer deaths in 2007 compared with 2000. Decreases in major cardiovascular risk factors were generally modest accounting for −37% of the total decrease in CHD mortality overall. This ranged from −50% in the most deprived quintile to −30% in the most affluent. The biggest contribution came from a fall in systolic blood pressure (−33%). Other gains were modest: total plasma cholesterol (−6%), smoking (−4%) and inactivity (−2%). Furthermore, these benefits were negated by increases in BMI and diabetes (+11%). Treatments accounted for approximately half the mortality decline across all social groups. The largest contributors were medical therapies in community settings for lipid reduction (−14%), chronic angina (−13%) and secondary prevention (−11%). Conclusions Much of the fall in CHD mortality in England between 2000 and 2007 was attributable to medical therapies, evenly distributed across social groups. This was unexpected, and probably reflects frustratingly small recent decreases in major cardiovascular risk factors, compounded by continuing rises in obesity and diabetes.

Assessment of sympathetic index from the Valsalva maneuver

Blood pressure (BP) decline and recovery during the Valsalva maneuver (VM) are used to evaluate the degree of sympathetic failure (SF) but a reliable sympathetic index (SI) derived from VM is lacking. Patients with mild (n=20), moderate (n=65), and severe (n=60) SF and 23 healthy controls were evaluated using a standardized battery of autonomic tests. SF was defined as mild (associated with reduced sudomotor volumes at distal leg); moderate (associated with a fall in systolic BP ≥10< 30 mm Hg during the tilt test); and severe (associated with a fall in systolic BP ≥30 mm Hg during the tilt test). Six SIs were compared: SI1 (BP fall during phase 2), SI2 (BP recovery during phase 2), SI3 (the difference in BP between baseline and the end of phase 2), SI4 (the magnitude of phase 4), SI5 (BP recovery time), and SI6 (baroreflex sensitivity index). All indexes showed overall significant differences among tested groups (p<0.05). Only SI3 differentiated all subject groups. Compared to other SIs, SI3 correlated the most with orthostatic hypotension (OH; r=0.62, p < 0.05) during the tilt. SI3 is the optimal method for calculation of SI since it 1) easily differentiates between healthy controls and those with SF; 2) correlates with the OH, a proxy for a sympathetic failure; 3) tracks the full spectrum of SF (mild-moderate-severe). SI3 expands the utility of quantitative autonomic testing.

Documented Intraoperative Hypotension According to the Three Most Common Definitions Does Not Match the Application of Antihypotensive Medication

This observational study investigated which of the three most common definitions of intraoperative hypotension (IOH), reported in a published systematic literature review, were associated best with anaesthetists' administration of antihypo tensive medication (AHM). IOH and AHM use in anaesthetic procedures in a mixed surgical population (n = 2350) were also reviewed. The definitions were: arterial systolic blood pressure (SBP) < 100 mmHg or a fall in SBP of > 30% of the preoperative SBP baseline; arterial SBP < 80 mmHg; a fall in SBP of > 20% of the preoperative SBP. Accuracy of predicting AHM using these three definitions was 67%, 54% and 65%, respectively. Prediction by a new fourth definition, using an optimal threshold of minimal SBP falling to < 92 mmHg or by > 24% of preoperative baseline, was 68% accurate. In multivariate logistic analysis, age, volatile versus intravenous anaesthetics, medical history of arterial hypertension and all four definitions of IOH were associated with intraoperative AHM, however IOH was not associated with postoperative in-patient stay. The three original definitions correlated poorly with the anaesthetist's judgement about applying AHM. Anaesthetists make complex decisions regarding the relevance of IOH, considering various perioperative factors in addition to SBP. Age, physical status and duration and type of surgery showed better correlations with postoperative in-patient stay than IOH.

ADDITION OF SPIRONOLACTONE IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION (ASPIRANT) - STUDY PROTOCOL

There is currently limited data on which drug should be used to improve blood pressure control in patients with resistant hypertension. Recent observational trials reported spironolactone as having good effects. This study is designed to assess the effect of the addition of 25 mg of spironolactone on blood pressure (BP) in patients with resistant arterial hypertension. Patients with office systolic BP > 140 mmHg or diastolic BP > 90 mmHg despite treatment with at least 3 antihypertensive drugs including a diuretic, are enrolled in this double-blind, placebo-controlled, multicentre trial. Patients are randomly assigned to receive spironolactone or a placebo at a ratio of 1:1 by the method of simple randomisation. Our primary endpoints are to show a statistically significant difference in the fall of mean day-time systolic and diastolic BP by ambulatory blood pressure monitoring (ABPM), between the spironolactone and placebo groups, after 8 weeks of treatment. Secondary outcomes are changes of serum potassium, natrium, creatinine, body weight, casual blood pressure in office, difference in the fall of mean night-time and 24-hour ABPM BP and treatment response depending on different baseline levels of aldosterone and aldosterone/PRA ratio. If spironolactone proves effective, it might become the standard of treatment in patients with resistant arterial hypertension.

The Alpha ( )-Glucosidase Inhibitor, Acarbose, Attenuates the Blood Pressure and Splanchnic Blood Flow Responses to Intraduodenal Sucrose in Older Adults

Postprandial hypotension is an important problem in the elderly and may be triggered by the increase in splanchnic blood flow induced by a meal. Acarbose attenuates the fall in blood pressure (BP) induced by oral sucrose and may be useful in the management of postprandial hypotension. It is not known whether the effect of acarbose on postprandial BP reflects slowing of gastric emptying and/or carbohydrate absorption nor whether acarbose affects splanchnic blood flow. We examined the effects of intraduodenal (ID) acarbose on the BP, heart rate, superior mesenteric artery (SMA) flow, and glycemic and insulin responses to ID sucrose in older participants--this approach excluded any "gastric" effect of acarbose. Eight healthy participants (four male and four female, age 66-77 years) received an ID infusion of sucrose (~6 kcal/min), with or without acarbose (100 mg), over 60 minutes. BP, heart rate, SMA flow, blood glucose, and serum insulin were measured. Acarbose markedly attenuated the falls in systolic (p < .01) and diastolic (p < .05) BP and rises in heart rate (p < .05), SMA flow (p < .05), blood glucose (p < .01), and serum insulin (p < .05). The maximum fall in systolic BP and peak SMA flow was inversely related on the control day (r(2) = -.53, p < .05) but not with acarbose (r(2) = .03, p = .70). We conclude that in healthy older participants receiving ID sucrose, (a) acarbose markedly attenuates the hypotensive response by slowing carbohydrate absorption and attenuating the rise in splanchnic blood flow and (b) the fall in BP is related to the concomitant increase in SMA flow.