Postprandial Hypotension (The Symptoms, Causes and Treatments)
Postprandial Hypotension is a dysfunction of the body whereby an individual's blood pressure drops abnormally (or suddenly) after eating a meal. The term Postprandial Hypotension (sometimes abbreviated as PPH) literally means: postprandial ("after eating") - hypotension ("low blood pressure").
And usually having low blood pressure is not a major problem. There are many people with low blood pressure whose bodies have managed to adjust to that reality. In fact, there are some who are diagnosed with PPH but show no inward or outward ill effects. The real problem with postprandial hypotension comes from the fact that your blood pressure drops without time for your body to react (make proper adjustments). Common symptoms for postprandial hypotension include the following:
List of Symptoms:
- Dizziness And/Or Lightheadedness After A Meal
- Disturbed Vision
- Angina (Chest Pain)
- Difficulty Concentrating
- Worst Case Scenario (though rare). Sufferers may suffer ischemic stroke.
- Possible Syncope (Loss of Consciousness)
What Causes Postprandial Hypotension?
The process of digestion is a complicated one that requires precise coordination by many different systems in the human body. Modern science has determined that the human body's circulatory, nervous and digestive systems all communicate in a timely manner to make sure that this process goes as smoothly as possible.
When food enters the stomach and intestinal tract, the body typically sends signals to allow more blood to collect around the abdominal organs. In fact, so much blood may start to collect around these organs, that the body takes extra steps to make sure that there is enough blood circulating throughout the rest of the body for proper function. Therefore during the process of digestion, your heart rate will typically increase and the blood vessels in your extremities will typically narrow to restrict excessive blood movement to your core.
In postprandial hypotension, something in this process goes awry. In some cases it's possible that one of the body's many blood pressure sensors stops working properly or (more typically) the body's ability to narrow blood vessels efficiently has been degraded. The net result is excessive pooling of the blood in abdominal cavities and arteries; coupled with a lack of circulating blood flow everywhere else.
Who Gets Postprandial Hypotension?
Beyond the technicals, there are a number of health and lifestyle factors that influence who gets PPH. I have listed a few of the most important ones below:
- Shows up in those with a history of high blood pressure, which has a tendency to stiffen arteries over time.
- Very prevalent in older adults. The aging process may wear down some of the mechanisms behind the digestion process.
- Very prevalent in those who have Parkinson's Disease
- Prevalent in those who are on dialysis
- The condition can arise from a stroke or physical trauma that affects key nerves in the body that play a part in digestion.
- A few people have a genetic predisposition to the condition.
As mentioned before, postprandial hypotension is particularly prevalent among the elderly. With fewer than 10% of cases showing up in persons under the age of 50. However, due to the variation in symptoms; official diagnoses of postprandial hypotension by medical practitioners is usually understated. The next section will cover some of the reasons why.
How well are you managing your Postprandial Hypotension (PPH)?
How is Postprandial Hypotension Diagnosed?
In many official medical texts, postprandial hypotension is defined as a "systolic blood pressure drop of 20 mm Hg in a sitting position within 120 minutes of eating a meal." [see ref. 1]. For reference's sake, the normal (ideal) blood pressure is 120/80, with 120 being the systolic blood pressure and 80 being the diastolic blood pressure. However, as I have mentioned before, symptoms can vary widely from person to person. And different individuals have different tolerances to these symptoms as well.
For example, the post-meal blood pressure drop that is characteristic of PPH does not occur at the same time for all individuals. For about 70% of individuals, the blood pressure drop occurs about 30 to 60 minutes after consuming a meal. For another 15%, the blood pressure drop occurs 75 to 120 minutes after eating a meal. For the remaining 15%, the blood pressure drop can occur a mere 15 minutes after consuming a meal.
Also, as mentioned before, postprandial hypotension is often underdiagnosed. The reason for this is because the conditions surrounding people's eating habits vary widely, making the cause of symptoms hard to pin down. For example, many people have a glass of water with some meals (but not with others). As you will see later on, consuming 12 to 18 glasses of water can increase your baseline blood pressure temporarily; thus potentially alleviating the effects of a sudden blood pressure drop.
Another important factor affecting diagnoses is whether or not an individual stands up soon after eating. Sitting for a prolonged period after a meal may actually help keep your blood pressure relatively stable (thus keeping symptoms in check). The blood pressure drop from PPH is most pronounced (and visible) when some stands up (becomes ambulatory) after a meal.
While there are some medications, treatments, and surgeries that have benefitted sufferers of postprandial hypotension in the past; the great majority of patients report that symptoms are best alleviated by making minor but consistent lifestyle changes. I have listed all the potential remedies here (while adding personal thoughts as necessary).
- After eating a meal, sit down anywhere from thirty minutes to an hour. For most sufferers, it takes about this amount of time for blood pressure to reach rock bottom. So sitting down should help you avoid the worst symptoms.
- 15 to 20 minutes before having a meal, dring approximately 15 to 20 ounces of water. Water can temporarily increase your blood pressure, making the sudden blood pressure drop from PPH less straining on the body. If your doctor will allow, you may consider adding a teaspoon of salt to the water as salt also help retain water and thus maintain higher blood pressure.
- Avoid Alcohol. Alcohol tends to relax blood vessels. Especially, those in the legs that prevent blood from pooling.
- Reduce the amount of rapidly digested carbohydrates that you eat. For example, avoid meals heavy in white rice, white bread and pasta. Instead, choose carbohydrates that are coupled with fiber, protein, and fat (i.e. brown rice, wheat bread, etc).
- Get some exercise between meals. Exercises such as light walking (20 minutes+) can improve vascular tone and flexibility, helping to alleviate symptoms when you eat.
Medications and Treatments:
- Caffeine. Caffeine and caffeine-containing drinks have been shown to constrict blood vessels. This may help reduce symptoms.
- Guar Gum. Ingesting guar gum may help alleviate symptoms. Guar gum is a water-soluble fiber that may help slow the release of food (esp. carbohydrates) into your digestive tract.
- Midodrine. A Medication used to increase blood pressure.
- Acarbose. Medication used to slow down the absorption of carbohydrates.
- NSAID's. Taking Non-Steroidal Anti-Inflammatory Drugs prior to consuming a meal may help alleviate symptoms. NSAIDs are known to allow the body to retain salt for an excessive amount of time.
- Octreotide Injections. Usually considered a last-ditch treatment for the most severe cases of postprandial hypotension. Ocreotide acts like somatostatin in the body (a hormone naturally produced in the pancreas). Injections of this chemical can help reduce blood flow to the intestines, therefore alleviating symptoms. However, injections are very expensive. Also, in most cases injections must happen before each meal.
On The Horizon:
You should be glad to know that progress is being made to discover the exact causes (or causes) behind postprandial hypotension and similarly related conditions. Scientists have located many components both genetic and physiological that contribute to the development or potential development of symptoms. Hopefully, this research will provide future generation will methods to better treat and cure this malady.
Note: If you think you are having problems with low blood pressure after eating a meal. Or low blood pressure after eating a large meal. Please contact your doctor. They can give you the right advice as to whether or not this is an autonomic disorder or otherwise.
1.) Postural and Postprandial Hypotension: Approach to Management