title: Acarbose, the α-glucosidase inhibitor, attenuates the blood pressure and splanchnic blood flow responses to meal in elderly patients with postprandial hypotension concomitant with abnormal glucose metabolism.
abstract: OBJECTIVE
  Postprandial hypotension (PPH) is a unique clinical phenomenon in the elderly, but its underlying pathogenesis has not been completely elucidated, and drug treatment is still in clinical exploratory stage. The aim of the study was to evaluate the relationship between the fall in postprandial blood pressure and splanchnic blood flow, and to provide a theoretical basis for the treatment of PPH by taking acarbose.
  
  
  METHODS
  The study included 20 elderly inpatients diagnosed with PPH concomitant with abnormal glucose metabolism at stable condition. They were treated with 50 mg acarbose with their meal to observe the changes in blood pressure, heart rate, and blood glucose level, and to monitor the hemodynamics of the superior mesenteric artery (SMA) before and after treatment.
  
  
  RESULTS
  Without acarbose treatment, patients after a meal had significantly decreased systolic and diastolic blood pressure, faster postprandial heart rate, higher postprandial glucose level at each period, and increased postprandial SMA blood flow compared with that at fasting state (P<0.05). Acarbose treatment significantly attenuated the decrease of postprandial systolic blood pressures from 35.50±12.66 to 22.25±6.90 mmHg (P=0.000), the increase of heart rate from 9.67±5.94 to 5.33±3.20 beats/min (P=0.016), the increase of postprandial blood glucose from 3.55±1.69 to 2.28±1.61 mmol/l (P=0.000), the increase of postprandial SMA blood flow from 496.80±147.15 to 374.55±97.89 ml/min (P=0.031), and the incidence of PPH, syncope, falls, dizziness, weakness, and angina pectoris (P<0.05). The maximal decrease of postprandial systolic blood pressure was positively associated with the maximal increase in postprandial SMA blood flow (r=0.351, P=0.026). Acarbose treatment showed no significant side effects.
  
  
  CONCLUSIONS
  The increase in postprandial splanchnic perfusion is one of the reasons for PPH formation. Acarbose may exert its role in PPH treatment by reducing postprandial gastrointestinal blood perfusion. Giving 50 mg acarbose with a meal to treat PPH concomitant with abnormal glucose metabolism is effective and safe in very old patients.
authors.affiliation: Departments of aSenior Ward bCardiology, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qiao
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Duan
authors.initials: D
authors.lastname: Qian
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Xiansen
authors.initials: X
authors.lastname: Wei
authors.forename: Jiangli
authors.initials: J
authors.lastname: Jin
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
mesh_terms: D020909:Acarbose / Q000627:therapeutic use*; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000187:drug effects; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D065089:Glycoside Hydrolase Inhibitors / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D019518:Postprandial Period / Q000187:drug effects; D000520:alpha-Glucosidases / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D065089:Glycoside Hydrolase Inhibitors; D000520:alpha-Glucosidases; D005947:Glucose; D020909:Acarbose