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摘要: 餐后低血压是指进食后出现的低血压现象，在老年人中常见，在糖尿病、高血压、帕金森等中同样高发，使上述群体罹患跌倒、晕厥和卒中的风险增加。餐后低血压与饮食密切相关，高糖饮食、热食都可能成为发病的危险因素。主流的学说认为餐后内脏血液灌流增多、胃肠道激素分泌增加和自主神经功能障碍是餐后低血压的主要发病机制。餐后低血压可以通过餐前饮水、改变饮食习惯、餐后恰当运动等非药物手段进行有效预防，而在药物治疗方面，目前已发现许多降血糖药物对餐后低血压具有很好的疗效。本文主要从流行病学、病理生理学机制和防治措施等方面对餐后低血压的研究进展进行综述，以期能找出目前对于餐后低血压防治的不足，使临床工作者重视餐后低血压的潜在危险性，并为今后的研究指明方向。Abstract: Postprandial hypotension refers to the phenomenon of hypotension after eating, which is common in the elderly, and also occurs frequently in patients with diabetes, hypertension and Parkinson, so that the risks of falls, syncope and stroke in these groups increase. Postprandial hypotension is closely related to diet. High-sugar diet and hot food may both be risk factors. The mainstream theory holds that the main pathogenesis of postprandial hypotension is growing visceral hemoperfusion, increased gastrointestinal hormone secretion and autonomic nerve dysfunction. Postprandial hypotension can be effectively prevented by non-drug means such as drinking water before meals, changing eating habits, proper exercise after meals, etc. As for drug treatment, many hypoglycemic drugs have been found clinically to have good curative effect on postprandial hypotension. This article mainly reviews the research progress of postprandial hypotension from the aspects of epidemiology, pathophysiological mechanism and prevention and treatment measures, hoping to find out the deficiency of prevention and treatment of postprandial hypotension at present, enhance the importance of postprandial hypotension and point out the direction for future research.
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Key words:
- postprandial hypotension /
- diet /
- gastric emptying /
- gastrointestinal hormones /
- drugs
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[1] Jansen RW, Lipsitz LA. Postprandial hypotension: epidemiology, pathophysiology, and clinical management[J]. Ann Intern Med, 1995, 122: 286-295. doi: 10.7326/0003-4819-122-4-199502150-00009
[2] Aronow WS, Ahn C. Postprandial hypotension in 499 elderly persons in a long-term health care facility[J]. J Am Geriatr Soc, 1994, 42: 930-932. doi: 10.1111/j.1532-5415.1994.tb06582.x
[3] Grodzicki T, Rajzer M, Fagard R, et al. Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension. Systolic Hypertension in Europe(SYSTEUR)Trial Investigators[J]. J Hum Hypertens, 1998, 12: 161-165. doi: 10.1038/sj.jhh.1000573
[4] Jang A. Postprandial hypotension as a risk factor for the development of new cardiovascular disease: a prospective cohort study with 36 month follow-up in community-dwelling elderly people[J]. J Clin Med, 2020, 9(2): 345. doi: 10.3390/jcm9020345
[5] Schoevaerdts D, Iacovelli M, Toussaint E, et al. Prevalence and risk factors of postprandial hypotension among elderly people admitted in a geriatric evaluation and management unit: an observational study[J]. J Nutr Health Aging, 2019, 23(10): 1026-1033. doi: 10.1007/s12603-019-1271-1
[6] Fisher AA, Davis MW, Srikusalanukul W, et al. Postprandial hypotension predicts all-cause mortality in older, low-level care residents[J]. J Am Geriatr Soc, 2005, 53: 1313-1320. doi: 10.1111/j.1532-5415.2005.53415.x
[7] de Ruiter SC, Wold JFH, Germans T, et al. Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway[J]. Europace, 2018, 20(5): 867-872. doi: 10.1093/europace/eux099
[8] Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension[J]. Am J Med, 2010, 123(3): 281. e1-6.
[9] Kitae A, Ushigome E, Hashimoto Y, et al. Asymptomatic postprandial hypotension in patients with diabetes: The KAMOGAWA-HBP study[J]. J Diabetes Investig, 2021, 12(5): 837-844. doi: 10.1111/jdi.13418
[10] Hashizume M, Kinami S, Sakurai K, et al. Postprandial blood pressure decrease in patients with type 2 diabetes and mild or severe cardiac autonomic dysfunction[J]. Int J Environ Res Public Health, 2019, 16(5): 812. doi: 10.3390/ijerph16050812
[11] Seyer-Hansen K. Postprandial hypotension[J]. Br Med J, 1977, 2: 1262.
[12] Mehagnoul-Schipper DJ, Boerman RH, Hoefnagels WH, et al. Effect of levodopa on orthostatic and postprandial hypotension in elderly Parkinsonian patients[J]. J Gerontol A Biol Sci Med Sci, 2001, 56: M749-755. doi: 10.1093/gerona/56.12.M749
[13] Shibao CA, Biaggioni I. Management of orthostatic hypotension, postprandial hypotension, and supine hypertension[J]. Semin Neurol, 2020, 40(5): 515-522. doi: 10.1055/s-0040-1713886
[14] Madden KM, Feldman B, Meneilly GS. Characteristics associated with the postprandial hypotensive response in falling older adults[J]. Can J Aging, 2019, 38(4): 434-440. doi: 10.1017/S0714980818000752
[15] Furukawa K, Suzuki T, Ishiguro H, et al. Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus[J]. Endocr J, 2020, 67(6): 585-592. doi: 10.1507/endocrj.EJ19-0370
[16] Zhang J, Guo L. Effectiveness of acarbose in treating elderly patients with diabetes with postprandial hypotension[J]. J Investig Med, 2017, 65(4): 772-783. doi: 10.1136/jim-2016-000295
[17] Sato K, Sugiura T, Ohte N, et al. Postprandial hypotension in older people receiving tube feeding through gastrostomy[J]. Geriatr Gerontol Int, 2018, 18(10): 1474-1478. doi: 10.1111/ggi.13515
[18] Pham H, Phillips LK, Jones KL. Acute effects of nutritive and non-nutritive sweeteners on postprandial blood pressure[J]. Nutrients, 2019, 11(8): 1717. doi: 10.3390/nu11081717
[19] Robinson TG, Potter JF. Postprandial and orthostatic cardiovascular changes after acute stroke[J]. Stroke, 1995, 26: 1811-1816. doi: 10.1161/01.STR.26.10.1811
[20] Mehagnoul-Schipper DJ, Boerman RH, Hoefnagels WH, et al. Effect of levodopa on orthostatic and postprandial hypotension in elderly Parkinsonian patients[J]. J Gerontol A Biol Sci Med Sci, 2001, 56: M749-M755. doi: 10.1093/gerona/56.12.M749
[21] Kuipers HM, Jansen RW, Peeters TL, et al. The influence of food temperature on postprandial blood pressure reduction and its relation to substance-P in healthy elderly subjects[J]. J Am Geriatr Soc, 1991, 39: 181-184. doi: 10.1111/j.1532-5415.1991.tb01623.x
[22] Hu H, Qiao W, Wang X, et al. Effect of blood insulin level on postprandial hypotension in elderly people[J]. Blood Press Monit, 2020, 25(4): 201-205. doi: 10.1097/MBP.0000000000000450
[23] Ishizeki A, Kishino T, Ogura S, et al. Influence of breakfast on hemodynamics after lunch-a sonographic evaluation of mesenteric and cervical blood flows[J]. Clin Physiol Funct Imaging, 2019, 39(3): 226-229. doi: 10.1111/cpf.12556
[24] Aronow WS, Ahn C. Postprandial hypotension in 499 elderly persons in a long-term health care facility[J]. J Am Geriatr Soc, 1994, 42: 930-932. doi: 10.1111/j.1532-5415.1994.tb06582.x
[25] Gabutti L, Del Giorno R. Vascular aging processes accelerate following a cubic kinetic: pulse wave velocity as an objective counterpart that time, as we age, goes by faster[J]. Clin Interv Aging, 2018, 13: 305-307. doi: 10.2147/CIA.S152070
[26] Madden KM, Feldman B, Meneilly GS. Baroreflex function and postprandial hypotension in older adults[J]. Clin Auton Res, 2021, 31(2): 273-280. doi: 10.1007/s10286-020-00671-8
[27] Gentilcore D, Jones KL, O'Donovan DG, et al. Postprandial hypotension-novel insights into pathophysiology and therapeutic implications[J]. Curr Vasc Pharmacol, 2006, 4(2): 161-171. doi: 10.2174/157016106776359826
[28] Grobéty B, Grasser EK, Yepuri G, et al. Postprandial hypotension in older adults: Can it be prevented by drinking water before the meal?[J]. Clin Nutr, 2015, 34(5): 885-891. doi: 10.1016/j.clnu.2014.09.009
[29] Dashti HS, Mogensen KM. Recommending small, frequent meals in the clinical care of adults: a review of the evidence and important considerations[J]. Nutr Clin Pract, 2017, 32(3): 365-377. doi: 10.1177/0884533616662995
[30] Zhang X, Jones KL, Horowitz M, et al. Effects of proximal and distal enteral glucose infusion on cardiovascular response in health and type 2 diabetes[J]. J Clin Endocrinol Metab, 2020, 105(8): 341.
[31] Sato K, Sugiura T, Ohte N, et al. Postprandial hypotension in older people receiving tube feeding through gastrostomy[J]. Geriatr Gerontol Int, 2018, 18(10): 1474-1478. doi: 10.1111/ggi.13515
[32] Darwiche G, Ostman EM, Liljeberg HG, et al. Measurements of the gastric emptying rate by use of ultrasonography: studies in humans using bread with added sodium propionate[J]. Am J Clin Nutr, 2001, 74: 254-258. doi: 10.1093/ajcn/74.2.254
[33] Pham H, Phillips LK, Jones KL. Acute effects of nutritive and non-nutritive sweeteners on postprandial blood pressure[J]. Nutrients, 2019, 11(8): 1717. doi: 10.3390/nu11081717
[34] Giezenaar C, Oberoi A, Jones KL, et al. Effects of age on blood pressure and heart rate responses to whey protein in younger and older men[J]. J Am Geriatr Soc, 2021, 69(5): 1291-1299. doi: 10.1111/jgs.17083
[35] Nair S, Visvanathan R, Gentilcore D. Intermittent walking: a potential treatment for older people with postprandial hypotension[J]. J Am Med Dir Assoc, 2015, 16(2): 160-164. doi: 10.1016/j.jamda.2014.08.013
[36] Trahair LG, Horowitz M, Stevens JE, et al. Effects of exogenous glucagon-like peptide-1 on blood pressure, heart rate, gastric emptying, mesenteric blood flow and glycaemic responses to oral glucose in older individuals with normal glucose tolerance or type 2 diabetes[J]. Diabetologia, 2015, 58: 1769-1778. doi: 10.1007/s00125-015-3638-0
[37] Wu T, Rayner CK, Horowitz M. Incretins[J]. Handb Exp Pharm, 2016, 233;137-171.
[38] Thazhath SS, Marathe CS, Wu T, et al. Acute effects of the glucagon-like peptide-1 receptor agonist, exenatide, on blood pressure and heart rate responses to intraduodenal glucose infusion in type 2 diabetes[J]. Diab Vasc Dis Res, 2017, 14(1): 59-63. doi: 10.1177/1479164116666761
[39] Jones KL, Rigda RS, Buttfield MDM, et al. Effects of lixisenatide on postprandial blood pressure, gastric emptying and glycaemia in healthy people and people with type 2 diabetes[J]. Diabetes Obes Metab, 2019, 21(5): 1158-1167. doi: 10.1111/dom.13633
[40] 周子华. 新型降糖药物的降压作用[J]. 临床心血管病杂志, 2021, 37(8): 692-694. doi: 10.13201/j.issn.1001-1439.2021.08.002
[41] Saito Y, Ishikawa J, Harada K. Postprandial and orthostatic hypotension treated by sitagliptin in a patient with dementia with Lewy Bodies[J]. Am J Case Rep, 2016, 17: 887-893. doi: 10.12659/AJCR.900620
[42] Saito Y, Ishikawa J, Harada K. Postprandial and orthostatic hypotension treated by sitagliptin in a patient with dementia with lewy bodies[J]. Am J Case Rep, 2016, 17: 887-893. doi: 10.12659/AJCR.900620
[43] Borg MJ, Jones KL, Sun Z, et al. Metformin attenuates the postprandial fall in blood pressure in type 2 diabetes[J]. Diabetes Obes Metab, 2019, 21(5): 1251-1254. doi: 10.1111/dom.13632
[44] 张义朋, 何奔. 2型糖尿病中降糖药与心力衰竭风险[J]. 临床心血管病杂志, 2021, 37(1): 16-21.
[45] O'Donovan D, Feinle-Bisset C, Chong C, et al. Intraduodenal guar attenuates the fall in blood pressure induced by glucose in healthy older adults[J]. J Gerontol A Biol Sci Med Sci, 2005, 60: 940-946. doi: 10.1093/gerona/60.7.940
[46] Jansen RW, Lipsitz LA. Postprandial hypotension: epidemiology, pathophysiology, and clinical management[J]. Ann Int Med, 1995, 122: 286-295. doi: 10.7326/0003-4819-122-4-199502150-00009
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