Pham Steven, Mock Gregory, Camferdam Robert
Internal Medicine, White County Medical Center, Searcy, USA.
Nephrology, White County Medical Center, Searcy, USA.
Cureus. 2024 Jun 14;16(6):e62378. doi: 10.7759/cureus.62378. eCollection 2024 Jun.
Postprandial hypotension (PPH) is characterized by a drop in blood pressure (BP) of at least 20 mmHg within 15 minutes to two hours after any meal. This phenomenon is observed in approximately half of patients with type 2 diabetes mellitus and can also affect otherwise healthy elderly patients. Prolonged instances of PPH can cause serious complications, including but not limited to dizziness, frequent falls, weakness, and even loss of consciousness. Nonpharmacologic interventions can help, such as discontinuing any exacerbating medications, increasing salt and water intake, adopting lifestyle modifications, and engaging in muscle tension-reducing exercises. When these strategies fail, pharmacological treatments may become necessary. Medications like midodrine (an alpha-adrenergic agonist) or droxidopa (a norepinephrine precursor) are commonly prescribed to help maintain BP. However, should BP persistently remain low despite these interventions, alternative therapies are explored. Acarbose, an antidiabetic medication, is an alpha-glucosidase inhibitor that targets pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolase. The inhibition slows glucose absorption, further reducing postprandial glucose blood concentrations. This case report presents the management of a 67-year-old woman with persistent PPH that is unresponsive to midodrine, atomoxetine, and sodium chloride tablets. The addition of acarbose to her regimen yields appropriate maintenance of BP after meals. The patient was able to be safely discharged home after.
餐后低血压（PPH）的特征是在进食后15分钟至两小时内血压（BP）至少下降20 mmHg。在大约一半的2型糖尿病患者中观察到这种现象，并且也可能影响其他方面健康的老年患者。PPH的长期发作可导致严重并发症，包括但不限于头晕、频繁跌倒、虚弱，甚至意识丧失。非药物干预措施可能会有所帮助，例如停用任何加剧病情的药物、增加盐和水的摄入量、采取生活方式改变以及进行减轻肌肉紧张的运动。当这些策略失败时，可能需要进行药物治疗。像米多君（一种α-肾上腺素能激动剂）或屈昔多巴（一种去甲肾上腺素前体）这样的药物通常被开出处方以帮助维持血压。然而，如果尽管采取了这些干预措施血压仍持续偏低，则会探索替代疗法。阿卡波糖是一种抗糖尿病药物，是一种α-葡萄糖苷酶抑制剂，作用于胰腺α-淀粉酶和膜结合的肠道α-葡萄糖苷水解酶。这种抑制作用减缓了葡萄糖的吸收，进一步降低了餐后血糖浓度。本病例报告介绍了一名67岁女性持续性PPH的治疗情况，该患者对米多君、托莫西汀和氯化钠片均无反应。在她的治疗方案中添加阿卡波糖后，餐后血压得到了适当维持。之后患者得以安全出院回家。
