Makindo Medical Notes.com

PPH is diagnosed by measuring the blood pressure changes associated with ingesting high carbohydrate test meals.

About

• Postprandial hypotension is a BP drop, with or without standing, after eating.
• More frequently observed in elderly patients with neurologic comorbidities, can be asymptomatic
• Commoner in Parkinson's disease, diabetes mellitus, and heart failure and renal failure

Aetiology

• The pathogenesis appears related to gastric and/or oesophageal distension
• Release of vasodilatory peptides and splanchnic blood pooling
• Increased splanchnic blood pooling
• Attenuated baroreflex function due to age- or hypertension-related impairment
• Inadequate sympathetic nerve firing or vascular responsiveness to norepinephrine
• Upregulation of vasoactive intestinal peptides
• Insulin-mediated vasodilation

Clinical

• Symptoms appear within 2 hours after food ingestion
• Particularly, with large and high-carbohydrate meals or alcohol intake.
• Often occurs outside the home and situational

Investigations

• U&E, FBC, LFTs, ECG, CXR, Cortisol if concerns
• L/S BP

Management

• Avoid large CHO meals with alcohol in those predisposed
• Rise gradually from sitting to standing (i.e., after being inactive or sitting on the toilet)
• Additional oral water bolus (i.e., about 400-500 mL within 5 minutes)
• Abdominal binder may reduce symptoms for patients prior to an outing or event
• Ensure hydrated.
• Pharmacological
  • Caffeine, has been used for stimulation of the sympathetic nervous system.
  • Somatostatin analogs, vasopressin, non-steroidal anti-inflammatory drugs (NSAIDs) have been used

References

• Orthostatic Hypotension: Management of a Complex, but Common, Medical Problem