Intended for healthcare professionals

Rapid response to:

Practice Rational Testing

Postural hypotension

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3128 (Published 16 June 2011) Cite this as: BMJ 2011;342:d3128

Rapid Response:

Postural and postprandial hypotension

Adrenergic function has been tested currently by means of the
presence of orthostatic hypotension; reduced supine, standing BP or
increase in plasma norepinephrine and impaired pressor response to
prolonged handgrip.

For patients with the benign disorders of reduced orthostatic tolerance (Schondorf and Low) or recurrent vasodepresor syncope, diagnostic methods
have been invoked: a prolonged tilt of up to 60 minutes, with extended
time needed to discover orthostatic tachycardia and increased oscillations
in HR and BP (methodology of head-up tilt testing in patients with
unexplained syncope. J Am Coll Cardiol 1991 ; 17: 125-130).

Other methods are vasodilatatory stimulus: sublingual trinitroglycerin (Low et al), postexercise tilt and lower body negative pressure and
prolonged tilt: the inotropic stimulation and decreased ventricular
volume (tilt, LBNP +/- isoproterenol) would activate unmyelinated
ventricular mechanoreceptor afferents and a vagally mediated
cardioinhibitory reflex.

Infusion of isoproterenol with the patient supine was useful detecting the
presence of beta-receptor supersensitivity manifest as an increased heart
rate, mainly in patients with POTS (postural orthostatic tachycardia syndrome).

The condition usually associated with PH is postprandial hypotension,
mainly in vegetative alterations and in diabetic population (Am Intern
Med 1995 ; 122: 284) and would be valuable as an example of molecular
pathways in BP modification.
Voglibose was described in such moments (Neurology 2006) (alpha-glucosidase inhibitor) and tested in a series of 11 people with PD, 6
with MSA, 11 with diabetes and 20 controls; measuring BP, blood glucose and
insulin levels. The glucose and insulin levels were unaltered but reduced
the fall in SBP and reduced PPH duration in about 35 minutes (pinpointing
the role of vasodilatation gastroenteric peptides and splanchnic blood
reserve).

Ref.

-Schondorf R , Low PA.Clinical Autonomic Disorders.Little Brown & Co
Boston

-Maruta T et al. Voglibose inhibits postprandial hypotension in neurologic
disorders and elderly people. Neurology 2006 ; 66: 1432-4.

Competing interests: No competing interests

07 July 2011
Sabino G Echebarria Mendieta
MD neurologist
H San Eloy ( Barakaldo-Bizkaia ) district clinics.Osakidetza-Basque Health Service