The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Postprandial Hypotension: Epidemiology, Pathophysiology, and Clinical Management

Rene W. M. M. Jansen, MD, PhD; and Lewis A. Lipsitz, MD
[+] Article, Author, and Disclosure Information

From Hebrew Rehabilitation Center for Aged, Beth Israel Hospital and Harvard University Medical School, Boston, Massachusetts. Requests for Reprints: Lewis A. Lipsitz, MD, Hebrew Rehabilitation Center for Aged, 1200 Centre Street, Boston, MA 02131. Grant Support: By a grant from the Dutch Stimulation Fund for Research of Aging (SOOM86-1-205), a Teaching Nursing Home Award (AG04390), a research grant (AGO9538), a Claude Pepper Geriatric Research and Training Center Grant (AG08812) from the National Institute on Aging, and a grant from the Van Helten Foundation of the Royal Netherlands Academy of Arts and Sciences.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(4):286-295. doi:10.7326/0003-4819-122-4-199502150-00009
Text Size: A A A

Objective: To show the clinical relevance of postprandial hypotension and to review its pathophysiology and management.

Data Sources: Articles on postprandial hypotension were identified through MEDLINE and bibliographies of relevant articles.

Study Selection: All articles and case reports describing meal-related hypotension in the elderly and in patients with autonomic failure.

Data Synthesis: Postprandial hypotension, defined as a decrease in systolic blood pressure of 20 mm Hg or more, may result in syncope, falls, dizziness, weakness, angina pectoris, and stroke. Postprandial hypotension is distinct from and probably more common than orthostatic hypotension. Because meal-related hypotension is particularly common in older hypertensive patients, it has important implications for the evaluation and management of hypertension. The mechanism of postprandial hypotension is not fully understood. Possible contributors include inadequate sympathetic nervous system compensation for meal-induced splanchnic blood pooling; impairments in baroreflex function; inadequate postprandial increases in cardiac output; and impaired peripheral vasoconstriction, insulin-induced vasodilation, and release of vasodilatory gastrointestinal peptides. Although caffeine is often recommended as treatment for postprandial hypotension, available data do not support its use. Octreotide, a somatostatin analog, has been shown to be effective, but it is expensive and must be given parenterally.

Conclusion: All physicians caring for elderly patients should be aware of the hypotensive effects of food intake and should consider postprandial hypotension in the evaluation of syncope, falls, dizziness, and other cerebral ischemic symptoms.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.