A case of postprandial hypotension in an elderly woman with diabetes mellitus and nervous system impairment

Postprandial hypotension (PPH) is commonly defined ory blood pressure monitoring (ABPM) [5] confirmed a by a blood pressure decrease of more than 20 mmHg decrease in systolic blood pressure of 50 mmHg or more within 2 h after a meal [1]. However, this limit may not fit within 90 min of the meal and no changes in heart rate. every clinical case. Indeed, while a decrease in blood PPH is frequent in the elderly, though often asymptopressure of more than 20 mmHg does not always cause matic. Diabetes mellitus may enhance PPH because of an any signs or symptoms in patients with metabolic diseases, impairment of the sympathetic nervous system [6]. The neurological system impairment, or Parkinson’s disease, a patient’s age is important because an old cardiovascular moderate decrease in blood pressure may have major system may amplify the effect of nervous system impairclinical consequences [2,3]. PPH may be more frequent ment in diabetes mellitus. In support of this view is the fact and dangerous in diabetic patients with nervous system that the heart rate did not change when the blood pressure impairment [4]. dropped. Our patient was hypertensive and her blood We report the case of a 73-year-old diabetic and pressure was not well controlled by therapy. Many reports hypertensive woman who was on regular insulin three suggest a relationship between systolic blood pressure and times a day. The patient had had hypertension for 5 years severity of PPH [6]. Our patient had an old cerebral and was taking an ACE inhibitor. She had a stroke at the ischemia that could have worsened the nervous system’s age of 70 (brain infarction on CT scan) with right functioning and self-regulation. PPH was a precipitating hemiplegia. When we saw her in the emergency room, she event in the subsequent three episodes of transitory iswas aphasic and had worsening right hemiplegia. Blood chemic attacks. pressure was 90/60 mmHg, heart rate 84 bpm, and We believe that in elderly diabetic patients, PPH repreglycemia 165 mg/dl. After 2 h, the patient’s condition sents a further expression of nervous system impairment improved and the blood pressure was 165/100 mmHg. A and that it should always be considered as a cause of major color Doppler ultrasound of the carotid arteries was cardiovascular accidents [7]. negative and a CT scan of the brain showed several old ischemic lesions. The ECG was normal. Ultrasound of the heart showed left ventricular hypertrophy. R eferences The patient came back to the emergency room twice with aphasia and low systolic blood pressure (,100 [1] T eramoto S, Akishita M, Fukuchi Y et al. Assessment of autonomic mmHg). Two additional CT scans did not show any function in elderly subject with postprandial hypotension. Hypertens significant changes. We suspected PPH on the basis of the Res 1997;20(4):257–61. temporal presentation of symptoms after meals. Ambulat[2] C ampanini M, Dugnani M, Ballare M et al. Hypertension as a major determinant of postprandial hypotension in the elderly. Am J Hypertens 1997;10(4, Part 2):G61. [3] C ampanini M, Lunati F, Zanotti E et al. New aspects of postprandial *Corresponding author. Tel. / fax: 139-321-373-3310. hypotension in the elderly. Am J Hypertens 1998;11(4, Part E-mail address: mauro.campanini@maggioreosp.novara.it (M. Cam2):Co48. panini). [4] S tevens MJ, Edmonds ME, Matthias CJ et al. Disabling postural