Case sharing
An 80-year-old man came into the clinic.
hypertension
It's been more than thirty years. Take medicine regularly at ordinary times, blood pressure control is still stable. In recent months, they've been popping up right after a full meal
dizzy
The old man did not care too much. Until a few days ago, I fell to the ground after eating because of dizziness, and bruised my head. Fortunately, I didn't break a bone. His family took a blood pressure test and found that the pressure was only 83mmHg. After examination, the old man is happening
After the meal
Low blood pressure
Postprandial hypotension is a common senile disease, prone to syncope and fall after meal, is an independent risk factor for cardiovascular and cerebrovascular adverse events in the elderly. Because elderly patients often coexist with many diseases, and the clinical manifestations of postprandial hypotension are not typical, high occult, high rate of missed diagnosis, so we should pay more attention to it.
01
What is postprandial hypotension?
Postprandial hypotension refers to the decrease of SBP of more than 20mmHg within 2 hours after meals, or the combination of preprandial SBP ≥100 mmHg and postprandial SBP < 90 mmHg, or the decrease of postprandial blood pressure that exceeds the threshold of cerebral vascular autoregulation
symptoms
02
How is postprandial hypotension diagnosed?
Routine diagnosis of postprandial hypotension includes 24-hour ambulatory blood pressure monitoring and blood pressure measurement before and 2 hours after meals.
Matters needing attention:
- 24-hour amBUlatory blood pressure monitoring requires adjustment of postprandial blood pressure measurement interval;
- Blood pressure measurement before and 2 hours after meals requires 8 blood pressure measurements within 2 hours.
03
Why can you produce hypotension after eat?
The pathogenesis of postprandial hypotension is not completely clear, and is the result of interaction and interaction of various mechanisms. If the elderly gastric emptyspeed up, sympathetic nervous system stimulation decreases, after the meal visceral blood flow increases, autonomic neuropathy, etc., all have an important role.
In healthy adults, reduced circulating blood volume is compensated for by activation of the sympathetic nervous system, peripheral vascular contraction, and increased heart rate and cardiac output. However, in the elderly, especially those with hypertension and diabetes, the regulatory capacity of the cardiovascular system and autonomic nervous system is reduced, resulting in lower postprandial blood pressure.
04
Low blood pressure after meal of old people produces easily below what circumstance?
There are two common triggers:
One is non-diet-related factors, including insufficient blood volume, excessive diuretics, excessive antihypertensive drugs, postural changes, etc.
On the other hand are diet-related factors, including a high-sugar diet, overeating, overeating, and sitting up eating. Common causes include diabetes, Parkinson's disease, kidney failure, and multiple organ failure.
05
How to prevent postprandial hypotension?
Individual comprehensive prevention and treatment should be carried out on the basis of positive correction of inducement and treatment of basic diseases. Non-drug therapy is particularly important.
Non-drug treatment measures mainly include:
(1) Eat small and frequent meals, drink water before meals, reduce carbohydrate intake, and lower food temperature appropriately;
(2) For elderly patients receiving stoma tube feeding, reduce the rate of intestinal nutrient infusion and avoid the use of antihypertensive drugs before infusion;
(3) Avoid taking antihypertensive drugs before meals and take them between meals.
(4) Appropriate psychological intervention can effectively reduce the degree of anxiety and depression in patients.
Symptomatic patients may consider additional medications, including medications that reduce visceral blood flow, inhibit glucose absorption, and increase peripheral vascular resistance.