Rate of Gastric Emptying is a Determinant of Postprandial Hypotension in Non-Insulin-Dependent Diabetes Mellitus

Jones, Karen L.; Tonkin, Anne; Horowitz, Michael; Wishart, Judith M.; Carney, B. I.; Guha, S.; Green, L.

doi:10.1042/cs0940065

Cited by 102 publications

(123 citation statements)

References 19 publications

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“…The rate of GE, which is a determinant (Jones et al. 1998), as well as a risk factor (Trahair et al. 2015), for PPH was comparable in the two groups; this lack of difference is likely to be attributable to the modest size of the two groups.…”

Section: Discussionmentioning

confidence: 99%

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Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

et al. 2017

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Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH. We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH. Eight healthy older subjects (age 71.0 ± 1.7 years) and eight subjects with PPH (age 75.5 ± 1.0 years) consumed a 300 mL drink of either water or 75 g glucose (including 150 mg 13C‐acetate) in randomized order. BP and heart rate (HR) were measured using an automatic device, SV, CO, and GLS by transthoracic echocardiography and gastric emptying by measurement of 13 CO 2. In both groups, glucose decreased systolic BP (P < 0.001) and increased HR, SV, and CO (P < 0.05 for all). The fall in systolic BP was greater (P < 0.05), and increase in HR less (P < 0.05), in the PPH group, with no difference in SV or CO. Water increased systolic BP (P < 0.05) in subjects with PPH and, in both groups, decreased HR (P < 0.05) without affecting SV, CO, or GLS. In subjects with PPH, the hypotensive response to glucose and the pressor response to water were related (R = −0.75, P < 0.05). These observations indicate that, in PPH, the hypotensive response to oral glucose is associated with inadequate compensatory increases in CO and HR, whereas the pressor response to water ingestion is maintained and, possibly, exaggerated.

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Section: Discussionmentioning

confidence: 99%

“…When GE is relatively more rapid (Jones et al. 1998), or glucose is infused intraduodenally at a faster rate (Trahair et al. 2012), the fall in systolic BP is greater.…”

Section: Introductionmentioning

confidence: 99%

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

et al. 2017

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“…However, in the elderly, PPH probably represents a continuum (i.e. in healthy older individuals there is predictably a postprandial fall in BP, which is not the case in healthy young [11]). Given our observations, evaluation of the effect of GLP-1 agonists on BP in PPH is indicated.…”

Section: Discussionmentioning

confidence: 99%

“…In healthy older individuals and patients with type 2 diabetes, the postprandial fall in BP and increase in superior mesenteric artery (SMA) blood flow are greater when the rate of gastric emptying (GE), or intraduodenal glucose infusion, is relatively faster [11,12], while gastric distension attenuates the fall in BP [13]. GE in healthy individuals exhibits a wide interindividual variation of~4-17 kJ/min (~1-4 kcal/min) [14]; this is increased in diabetes because of the high prevalence of delayed [15], and occasionally rapid, GE [16].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Aims/hypothesis A postprandial fall in BP occurs frequently in older individuals and in patients with type 2 diabetes. The magnitude of this decrease in BP is related to the rate of gastric emptying (GE). Intravenous administration of glucagon-like peptide-1 (GLP-1) attenuates the hypotensive response to intraduodenal glucose in healthy older individuals. We sought to determine the effects of exogenous GLP-1 on BP, GE, superior mesenteric artery (SMA) flow and glycaemic response to oral ingestion of glucose in healthy older individuals and patients with type 2 diabetes. Methods Fourteen older volunteers (six men, eight women; age 72.1±1.1 years) and ten patients with type 2 diabetes (six men, four women; age 68.7±3.4 years; HbA 1c 6.6±0.2% [48.5± 2.0 mmol/mol]; nine with blood glucose managed with metformin, two with a sulfonylurea and one with a dipeptidyl-peptidase 4 inhibitor) received an i.v. infusion of GLP-1 (0.9 pmol kg −1 min −1 ) or saline (154 mmol/l NaCl) for 150 min (t=−30 min to t= 120 min) in randomised order. At t=0 min, volunteers consumed a radiolabelled 75 g glucose drink. BP was assessed with an automated device, GE by scintigraphy and SMA flow by ultrasonography. Blood glucose and serum insulin were measured. Results GLP-1 attenuated the fall in diastolic BP after the glucose drink in older individuals (p<0.05) and attenuated the fall in systolic and diastolic BP in patients with type 2 diabetes (p<0.05). GE was faster in patients with type 2 diabetes than in healthy individuals (p<0.05). In both groups, individuals had slower GE (p<0.001), decreased SMA flow (p<0.05) and a lower degree of glycaemia (p<0.001) when receiving GLP-1. Conclusions/interpretation Intravenous GLP-1 attenuates the hypotensive response to orally administered glucose and decreases SMA flow, probably by slowing GE. GLP-1 and 'short-acting' GLP-1 agonists may be useful in the management of postprandial hypotension.

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“…The onset of the fall in blood pressure after a meal is almost immediate, with a maximum response at 30 -60 min (16), suggesting a direct relationship between the magnitude of the hypotensive response and the rate of delivery of carbohydrate to the small intestine. This is the case in both healthy older subjects (18,32) and patients with type 2 diabetes (19,36) and has been established by a series of studies by our group. For example, in healthy older subjects when glucose is administered intraduodenally at a rate of 1 kcal/min or 3 kcal/min, the fall in blood pressure and increase in heart rate are substantially greater during the 3 kcal/min infusion (31).…”

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confidence: 99%

Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects

Gentilcore

Little²,

Feinle‐Bisset³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

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Gentilcore D, Little TJ, Feinle-Bisset C, Samsom M, Smout AJ, Horowitz M, Jones KL. Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects. Am J Physiol Gastrointest Liver Physiol 293: G692-G698, 2007. First published August 9, 2007; doi:10.1152/ajpgi.00199.2007.-Postprandial hypotension is an important clinical problem, particularly in the elderly. 5-Hydroxytryptamine3 (5-HT3) mechanisms may be important in the regulation of splanchnic blood flow and blood pressure (BP), and in mediating the effects of small intestinal nutrients on gastrointestinal motility. The aims of this study were to evaluate the effects of the 5-HT3 antagonist granisetron on the BP, heart rate (HR), and antropyloroduodenal (APD) motility responses to intraduodenal glucose in healthy older subjects. Ten subjects (5 male, 5 female, aged 65-76 yr) received an intraduodenal glucose infusion (3 kcal/min) for 60 min (t ϭ 0 -60 min), followed by intraduodenal saline for a further 60 min (t ϭ 60 -120 min) on 2 days. Granisetron (10 g/kg) or control (saline) was given intravenously at t ϭ Ϫ25 min. BP (systolic and diastolic), HR, and APD pressures were measured. Pressure waves in the duodenal channel closest ("local") to the infusion site were quantified separately. During intraduodenal glucose, there were falls in systolic and diastolic BP and a rise in HR (P Ͻ 0.0001 for all); granisetron had no effect on these responses. Granisetron suppressed the number and amplitude (P Ͻ 0.05 for both) of local duodenal pressures during intraduodenal glucose. Otherwise, the effects of intraduodenal glucose on APD motility did not differ between study days. We conclude that in healthy older subjects, 5-HT3 mechanisms modulate the local duodenal motor effects of, but not the cardiovascular responses to, small intestinal glucose. heart rate; 5-hydroxytryptamine3; granisetron; intraduodenal glucose; antropyloroduodenal motility POSTPRANDIAL HYPOTENSION, defined as a fall in systolic blood pressure of Ն20 mmHg within 2 h of a meal that is sustained for at least 30 min, is now recognized as a major cause of morbidity and mortality (7, 16) by predisposing to a number of disorders, including syncope, transient ischemic attacks, stroke, and angina (16). Postprandial hypotension occurs more frequently than orthostatic hypotension (16), and those at greatest risk include the elderly and patients with autonomic dysfunction, the latter usually secondary to diabetes (16). Current treatment options are suboptimal.Several factors, including impaired regulation of splanchnic blood flow, the release of gastrointestinal hormones, and duodenal sympathetic nerve activity, have been identified as possible pathophysiological mechanisms in postprandial hypotension (16). The magnitude of the fall in blood pressure is dependent on meal composition; ingestion of carbohydrate, particularly glucose, has been reported to have the greatest suppressive effect on blood pressure (17). Th...

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Rate of Gastric Emptying is a Determinant of Postprandial Hypotension in Non-Insulin-Dependent Diabetes Mellitus

Cited by 102 publications

References 19 publications

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

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

Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects

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