Management - Postprandial Hypotension

Cease medication causing postprandial hypotension

• Ideally any drug which may be causing postprandial hypotension should be ceased and an alternative one prescribed for the original indication.
• Postprandial hypotension often is post significant after breakfast.
  • Patients may be hypertensive at other times.
  • Consider moving the timing of medications that lower blood pressure to midmorning, midafternoon or use longacting antihypertensives at night-time if possible.

Advice

This forms the cornerstone of treatment for postprandial hypotension. As it requires longterm lifestyle changes, the advice needs to be clearly explained and tailored for each individual. Follow up will be required to assess the success (or failure) and compliance of each component.

• eat more frequent, smaller meals
• avoid additional factors exacerbating hypotension, such as
  • alcohol
  • dehydration
  • hot environment
  • rapid standing up after meals
  • taking anti-hypertensive medications just before meals.
• lie down immediately if you develop characteristic prodromal symptoms and tell someone nearby that you feel faint.

Drinking water before meals

Drinking 500ml of room temperature tap water in 5 minutes, substantially improves postprandial blood pressure in those with autonomic dysfunction. The effect occurs within a few minutes and lasts for an hour, with the maximum effect after half an hour.

Drinking strong coffee before meals

Medications

Midodrine

 

Pseudoephedrine

 

Octreotide

• A somatostatin analogue, has been shown to be effective in postprandial hypotension.
• It most likely works by increasing splanchnic and peripheral blood vessel constriction. However octreotide has to be given via a subcutaneous injection.
• The injection solution is acidic, so it causes irritation and pain at the injection site.
• It should only be prescribed by a specialist and is rarely used due to its' expense.