Postprandial hypotension in neurological disorders: systematic review and meta-analysis

  title={Postprandial hypotension in neurological disorders: systematic review and meta-analysis},
  author={Ante Paveli{\'c} and Magdalena Krbot Skori{\'c} and Luka Crno{\vs}ija and Mario Habek},
  journal={Clinical Autonomic Research},
PurposePostprandial hypotension (PPH) has been associated with increased risk of syncope, falls, stroke, angina and mortality. As the majority of patients with PPH are asymptomatic, the diagnosis is often overlooked. The aim of this study was to perform a systematic review and meta-analysis of available scientific evidence on the likelihood of PPH in neurological diseases.MethodsA systematic review of the literature (PubMed library, Cochrane Database for Systematic Reviews and Cochrane Central… 
Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies
  • J. Palma, H. Kaufmann
  • Medicine
    Movement disorders : official journal of the Movement Disorder Society
  • 2018
The treatment of autonomic dysfunction in patients with Parkinson disease and other synucleinopathies is reviewed, the nonpharmacological and current pharmacological therapeutic strategies including recently approved drugs are summarized, and practical advice and management algorithms for clinicians are provided.
Orthostatic Hypotension in Older Adults
It is concluded that orthostatic hypotension is common in the elderly and increases with advancing age, and is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis.
Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis and management
Droxidopa (Northera®), a synthetic norepinephrine precursor, has shown efficacy in controlled trials of neurogenic orthostatic hypotension in patients with hereditary TTR amyloidosis and is now approved in the US and Asia.
Neurogenic Orthostatic Hypotension. Lessons From Synucleinopathies.
Treatment for NOH is to improve quality of life and prevent syncope and falls by reducing symptoms of cerebral hypoperfusion, and drugs that enhance residual sympathetic tone are more effective in patients with mild disease and in MSA patients with spared postganglionic fibers.
A case of postprandial hypotension in an individual with cervical spinal cord injury: treatment with acarbose
A 62-year-old woman with long-standing cervical SCI presented with 5 years of worsening postprandial lightheadedness, visual “flashes”, and neck pain is treated with acarbose, one of the several established treatments for PPH, and proved effective and tolerable for her patient.
Stroke and Hypotensive Syndromes
A constantly growing body of evidence points at the close association between hypotension and stroke in the elderly and the clinical and pathophysiological meaning of hypotensive syndromes including the influence on the short- and long- term clinical outcome, therapy and rehabilitation success, and all day living of stroke patients.
Management of Orthostatic Hypotension.
Management of orthostatic hypotension is aimed at improving quality of life and reducing symptoms rather than at normalizing blood pressure, and nonpharmacologic measures are the key to success.
Cardiovascular autonomic failure in Parkinson's disease
Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives
An overview of established and emerging assessment methods of physiological function within the gut and Assessment methods of autonomic neuropathy outside the gut is provided, especially in regards to clinical performance, strengths, and limitations for each method.


Postprandial hypotension: a systematic review.
Evaluation of Cardiac Autonomic Functions in Older Parkinson's Disease Patients: a Cross-Sectional Study.
Although there are tests for assessing cardiovascular autonomic function that are more reliable, they are more complicated, and evaluation of orthostatic hypotension by blood pressure measurement and cardiac autonomic tests by electrocardiography are recommended since these tests are cheap and easy.
Autonomic and Cognitive dysfunction in Parkinson’s disease
The results of this limited study indicate that despite the higher incidence of cardiovascular symptoms in PD patients with dementia than in those without dementia, there is no consistent association between OH or PPH and cognitive deficits in PD.
Effect of levodopa on orthostatic and postprandial hypotension in elderly Parkinsonian patients.
Doses of levodopa/benserazide, administered 2 times per day, did not result in significantly larger blood pressure decreases after standing or eating, or in higher frequencies of orthostatic or postprandial hypotension in the Parkinsonian group.
Postprandial Hypotension: Epidemiology, Pathophysiology, and Clinical Management
The current knowledge of the epidemiology, clinical symptoms and significance, pathophysiology, and management of postprandial hypotension is reviewed to make the practicing physician more aware of this common abnormality in blood pressure regulation and to stimulate new research of its mechanisms and management.
Postprandial and orthostatic hypotension in Parkinson's disease
Analysis of 24-hour pattern of blood pressure, heart rate, and urinary catecholamine excretion and the response of BP and plasma CA to the tilt test suggests the existence of a subtype of PD patient, characterized by a widespread impairment of cardiovascular responsiveness and bordering on syndromes of autonomic failure such as progressive autonomic failures or multiple system atrophy.
Postprandial hypotension in elderly patients with unexplained syncope.
The evaluation of syncope in elderly patients should include blood pressure measurements surrounding a meal, because elderly patients with syncope who have postprandial hypotension fail to maintain systemic vascular resistance, probably because of splanchnic blood pooling without a compensatory increase in peripheral vascular resistance.
Intraindividual Reproducibility of Postprandial Hypotension
The diagnosis of PPH may be based on a single standardized test, however, the test must be performed under circumstances similar to those in which the symptoms occurred, and the good reproducibility of postprandial BP changes is concluded.
Humoral mechanisms in the pathogenesis of postprandial hypotension in patients with essential hypertension.
In patients with essential hypertension, a marked decline in postprandial systolic blood pressure is associated with lower postpr andial levels of norepinephrine, epinephrine and dopamine as compared to subjects without post prandial hypotension, indicating that impaired sympatho-adrenal activation after ingestion of a meal may contribute to the development of PPH.