Postprandial Hypotension: Epidemiology, Pathophysiology, and Clinical Management

OBJECTIVE: To show the clinical relevance of postprandial hypotension and to review its pathophysiology and management. DATA SOURCES: Articles on postprandial hypotension were identified through MEDLINE and bibliographies of relevant articles. STUDY SELECTION: All articles and case reports describing meal-related hypotension in the elderly and in patients with autonomic failure. DATA SYNTHESIS: Postprandial hypotension, defined as a decrease in systolic blood pressure of 20 mm Hg or more, may result in syncope, falls, dizziness, weakness, angina pectoris, and stroke. Postprandial hypotension is distinct from and probably more common than orthostatic hypotension. Because meal-related hypotension is particularly common in older hypertensive patients, it has important implications for the evaluation and management of hypertension. The mechanism of postprandial hypotension is not fully understood. Possible contributors include inadequate sympathetic nervous system compensation for meal-induced splanchnic blood pooling; impairments in baroreflex function; inadequate postprandial increases in cardiac output; and impaired peripheral vasoconstriction, insulin-induced vasodilation, and release of vasodilatory gastrointestinal peptides. Although caffeine is often recommended as treatment for postprandial hypotension, available data do not support its use. Octreotide, a somatostatin analog, has been shown to be effective, but it is expensive and must be given parenterally. CONCLUSION: All physicians caring for elderly patients should be aware of the hypotensive effects of food intake and should consider postprandial hypotension in the evaluation of syncope, falls, dizziness, and other cerebral ischemic symptoms.