Dr. Ron’s Research Review – December 18, 2013

© 2013

This week’s research review focuses on postprandial hypertension.

A recent study published in Atherosclerosis examined postprandial changes in BP in 1339 apparently healthy middle-aged to elderly persons.

Mean preprandial and postprandial systolic BP was 127 +/- 18 and 123 +/- 18 mmHg respectively. One hundred and twelve subjects (8.4%) showed a greater than 20-mmHg postprandial decline in systolic BP, while 129 (9.6%) showed a greater than 10-mmHg increase. Arteriosclerosis was significantly higher in both postprandial hypotensive and hypertensive subjects. The postprandial changes in systolic BP were strongly associated with preprandial systolic BP (r = 0.335, p < 0.001). The association between postprandial hypotension and increased arteriosclerosis was therefore lost after adjustment for basal systolic BP.

Analysis found a postprandial increase in BP as an independent determinant of insulin resistance as assessed by HOMA-IR (beta = 0.093, p < 0.001), carotid thickness (beta = 0.086, p = 0.001) and pulse wave velocity (beta = 0.170, p < 0.001). (Uetani, Tabara et al. 2012)

A study published in Hypertension showed that postprandial hyperinsulinemia in patients with mild essential hypertension may provoke lipid accumulation in the arterial wall and therefore may be a relevant risk factor for atherosclerosis. (Singer, Godicke et al. 1985)

Postprandial hypotension, common in the elderly, is a cause of syncope. Risk groups are patients with autonomic dysfunction in diabetes mellitus, hypertension, Alzheimer’s disease and Parkinson’s disease although PPH has been reported to occur in 33% of healthy individuals. (Van Orshoven, Jansen et al. 2010)

Dr. Ron


Articles

Postprandial hyperinsulinemia in patients with mild essential hypertension

(Singer, Godicke et al. 1985) Download

Glucose tolerance tests and diurnal profiles of glucose, insulin, free fatty acids, serum triglycerides, total and high-density lipoprotein cholesterol levels were performed in 8 male patients with mild essential hypertension as well as in 20 normotensive subjects. Although glucose tolerance and postprandial glucose levels appeared equal in both groups, the insulin response after a glucose load and after each meal was significantly increased in hypertensive subjects as compared with the controls (p less than 0.01). The levels of free fatty acids were higher in the postabsorptive phase of patients with hypertension in comparison to normotensive subjects, but decreased markedly when plasma insulin levels rose after meals. In both subject groups serum triglyceride levels showed the typical postprandial increase. Total and high-density lipoprotein cholesterol levels showed neither diurnal variations nor differences between hypertensive subjects and normotensive controls. Postprandial hyperinsulinemia in patients with mild essential hypertension possibly may provoke lipid accumulation in the arterial wall and therefore may be a relevant risk factor for atherosclerosis in these subjects.

Postprandial hypertension, an overlooked risk marker for arteriosclerosis

(Uetani, Tabara et al. 2012) Download

OBJECTIVE: Increased blood pressure (BP) variability is suggested to be a risk factor for cardiovascular disease. Although a postprandial decline in BP is a frequently observed phenomenon in the elderly, little attention has been paid to the clinical and diagnostic significance of postprandial BP change. Here, we aimed to clarify the possible association between postprandial BP dysregulation and arteriosclerosis. METHODS: The study subjects were 1339 apparently healthy middle-aged to elderly persons (66 +/- 9 years old). Postprandial changes in BP were calculated by two readings on the same day, one just before lunch with a standardized Japanese meal and the second 30 min after lunch. Arteriosclerosis was assessed by carotid intima-media thickness and brachial-to-ankle pulse wave velocity. RESULTS: Mean preprandial and postprandial systolic BP was 127 +/- 18 and 123 +/- 18 mmHg respectively. One hundred and twelve subjects (8.4%) showed a greater than 20-mmHg postprandial decline in systolic BP, while 129 (9.6%) showed a greater than 10-mmHg increase. Arteriosclerosis was significantly higher in both postprandial hypotensive and hypertensive subjects. The postprandial changes in systolic BP were strongly associated with preprandial systolic BP (r = 0.335, p < 0.001). The association between postprandial hypotension and increased arteriosclerosis was therefore lost after adjustment for basal systolic BP. Multiple linear regression analysis adjusted for possible covariates, including basal BP, identified a postprandial increase in BP as an independent determinant of insulin resistance as assessed by HOMA-IR (beta = 0.093, p < 0.001), carotid thickness (beta = 0.086, p = 0.001) and pulse wave velocity (beta = 0.170, p < 0.001). CONCLUSION: Postprandial increase in BP is a novel risk marker for arteriosclerosis.

Postprandial hypotension in clinical geriatric patients and healthy elderly: prevalence related to patient selection and diagnostic criteria

(Van Orshoven, Jansen et al. 2010) Download

The aims of this study were to find out whether Postprandial hypotension (PPH) occurs more frequently in patients admitted to a geriatric ward than in healthy elderly individuals, what the optimal interval between blood pressure measurements is in order to diagnose PPH and how often it is associated with symptoms.The result of this study indicates that PPH is present in a high number of frail elderly, but also in a few healthy older persons. Measuring blood pressure at least every 10 minutes for 60 minutes after breakfast will adequately diagnose PPH, defined as >20 mmHg systolic fall, in most patients. However with definition of PPH as >30 mmHg systolic fall, measuring blood pressure every 10 minutes will miss PPH in one of three patients. With the latter definition of PPH the presence of postprandial complaints is not associated with the existence of PPH.


References

Singer, P., W. Godicke, et al. (1985). "Postprandial hyperinsulinemia in patients with mild essential hypertension." Hypertension 7(2): 182-6. [PMID: 3884502]

Uetani, E., Y. Tabara, et al. (2012). "Postprandial hypertension, an overlooked risk marker for arteriosclerosis." Atherosclerosis 224(2): 500-5. [PMID: 22867753]

Van Orshoven, N. P., P. A. Jansen, et al. (2010). "Postprandial hypotension in clinical geriatric patients and healthy elderly: prevalence related to patient selection and diagnostic criteria." J Aging Res 2010: 243752. [PMID: 21152196]