Postprandial hypotension. Pathophysiological mechanisms and clinical implications in different disorders.

Mathias, C. J.

doi:10.1161/01.hyp.18.5.694

Cited by 91 publications

(78 citation statements)

References 36 publications

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Section: Discussionmentioning

confidence: 99%

“…During feeding, a variety of circulatory changes occur that are associated with the motor and autonomic components of ingestion (27). It has been described that during the cephalic phase of the ingestion, aterial pressure increases, whereas during the postprandial period, a vasodilation of the mesenteric vascular bed occurs (27). The observation that microinjection of Hcrt into the rostral ventrolateral medulla, the site of origin of the sympathetic premotor neurons (5), results in an increase in MAP and HR (4) suggests that at this level, orexin pathways may be involved in the integration between the motor and the cardiovascular systems related to both obtaining food and the ingestion of the food.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular effects of hypocretin-1 in nucleus of the solitary tract

Oliveira

Rosas‐Arellano

Solano-Flores

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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lar effects of hypocretin-1 in nucleus of the solitary tract. Am J Physiol Heart Circ Physiol 284: H1369-H1377, 2003. First published December 12, 2002 10.1152/ajpheart.00877.2002Experiments were done in male Wistar rats to investigate the effects of microinjection of hypocretin-1 (Hcrt-1) into the nucleus of the solitary tract (NTS) on mean arterial pressure (MAP), heart rate (HR), and the baroreflex. In the first series, the distribution of Hcrt-1-like immunoreactivity (Ir) was mapped within the region of NTS. Hcrt-1 Ir was found throughout the NTS region, predominantly within the caudal dorsolateral (Slt), medial (Sm), and interstitial subnuclei of the NTS. In the second series, in ␣-chloralose or urethaneanesthetized rats, microinjection of Hcrt-1 (0.5-5 pmol) into the caudal NTS elicited a dose-dependent decrease in MAP and HR. A mapping of the caudal NTS region showed that the largest depressor and bradycardia responses elicited by Hcrt-1 were from sites in the Slt and Sm. In addition, doses Ͼ2.5 pmol at a small number of sites localized to the caudal commissural nucleus of NTS elicited pressor and tachycardia responses. Intravenous administration of the muscarinic receptor blocker atropine methyl bromide abolished the bradycardia response and attenuated the depressor response, whereas subsequent administration of the nicotinic receptor blocker hexamethonium bromide abolished the remaining MAP response. Finally, microinjection of Hcrt-1 into the NTS significantly potentiated the reflex bradycardia to activation of arterial baroreceptors as a result of increasing MAP by systemic injections of phenylephrine (2-4 g/kg). These results suggest that Hcrt-1 in the NTS activates neuronal circuits that increases vagal activity to the heart, inhibits sympathetic activity to the heart and vasculature, and alters the excitability of NTS neuronal circuits that reflexly control the circulation.orexin-A; blood pressure; baroreceptor reflex; brain stem; ingestive behavior HYPOCRETIN (Hcrt) neuropeptides have been recently shown to be almost exclusively expressed within neurons of the lateral and perifornical hypothalamic areas (30,33,35,47,49). These peptides, Hcrt-1, a 33 amino-acid peptide with an NH 2 -terminal pyrogutalmyl residue, and Hcrt-2, a 28 amino acid peptide with a COOH-terminal amide (35), are de-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiovascular effects of hypocretin-1 in nucleus of the solitary tract

Oliveira

Rosas‐Arellano

Solano-Flores

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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“…[1][2][3] Although the underlying mechanisms are not well established, the increase in concentration of vasoactive gastrointestinal peptides or insulin-related vasodilatation have been in the 2 h before and after the meal, both SBP and DBP decreased significantly (respectively −6.6 mm Hg, −5.4 mm Hg; P Ͻ 0.001). In 67.6% of all patients a decrease in SBP was observed and in 24.1% it exceeded 16 mm Hg.…”

Section: Introductionmentioning

confidence: 99%

“…1,4 Ageassociated cardiovascular changes such as arterial stiffness and left ventricular diastolic dysfunction may cumulatively produce alterations in BP regulatory mechanisms that impair an older person's ability to adapt to hypotensive stress. 5 Moreover, the blunted baroreceptor reaction in elderly hypertensive patients may be partially responsible for profound postprandial hypotention.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension

et al. 1998

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The present analysis was undertaken to evaluate postprandial (PP) changes in blood pressure (BP) assessed with ambulatory BP monitoring (ABPM) in elderly subjects with isolated systolic hypertension (ISH) on conventional measurement. A total of 530 patients (335 women and 195 men, aged 60-100 years, median 70 years) who performed an ABPM during the placebo runin period of the Syst-Eur trial were included into the analysis. The PP changes in BP and heart rate (HR) were calculated by subtracting the mean systolic BP (SBP), diastolic BP (DBP) and HR in the 2 h preceding the main meal from the corresponding means covering the 2 h after the meal. The reproducibility of the postprandial fall in BP and heart rate (PPH) was assessed by contrasting the first and second ABPM in a subgroup of 147 patients who performed two ABPM's during the placebo run-in period. The mean SBP and DBP decreased and reached the nadir 2 h after the main meal while HR did not change. When PPH was assessed by comparing BP

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“…The mechanism has not yet been su ciently explained. 12 When a tetraplegic person su ers from postprandial hypotension the best advice for such an individual is to lie down for an hour after a meal. Defecation can also cause hypotension when it necessitates a strong push against the closed glottis (Valsalva manoeuver).…”

Section: Oh and The Intestinal Functionsmentioning

confidence: 99%

About orthostatic hypotension in tetraplegic individuals reflections and experience

Maury

1998

Spinal Cord

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The author recalls the role of the autonomic nervous system and the means of investigation of this system in orthostatic hypotension occurring in tetraplegic individuals and the haemodynamic, biochemical and humoral changes which are triggered by upward tilting of such people. He then considers some of the problems that a person who is tetraplegic may encounter during his life. Regular follow up of each tetraplegic person is necessary and includes respiratory function tests as well as 24 h blood pressure monitoring.

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Postprandial hypotension. Pathophysiological mechanisms and clinical implications in different disorders.

Cited by 91 publications

References 36 publications

Cardiovascular effects of hypocretin-1 in nucleus of the solitary tract

Cardiovascular effects of hypocretin-1 in nucleus of the solitary tract

Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension

About orthostatic hypotension in tetraplegic individuals reflections and experience

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