Hypertensive patients should be wary of postprandial hypotension: symptoms and coping strategies

Symptoms and dangers of orthostatic hypotension: Common symptoms include dizziness, weakness, fainting, angina, and transient ischemic attacks (TIAs). The biggest problem with orthostatic hypotension is that it increases the risk of cardiovascular disease death, coronary heart disease, heart failure, and stroke, especially for the elderly, increasing the risk of repeated falls and weakness, severely impacting their quality of life.

How to prevent orthostatic hypotension:

1. Patients should move slowly when standing, performing light limb movements before standing; after waking up, wait a few minutes before sitting up, then sit on the edge of the bed for 1-3 minutes, gradually transitioning to a standing position. This helps promote venous blood return to the heart, reducing the probability of orthostatic hypotension.

2. Patients should minimize bed rest time.

3. Avoid excessively hot bath water or prolonged bathing.

4. When orthostatic hypotension causes symptoms, patients should squat, sit, or lie down to help maintain blood pressure and cerebral perfusion.

5. For patients with primary hypertension complicated by orthostatic hypotension, simply aiming to lower blood pressure is insufficient; maintaining stable blood pressure is more important.

Non-pharmacological treatment: Although some small-scale clinical studies exist, the safety and efficacy of non-pharmacological treatments remain uncertain. The main methods include physical therapies and dietary measures. Patients should maintain appropriate physical exercise, such as swimming, aerobics, and walking, to improve their physical condition, but should avoid overexertion and prolonged standing. Sleeping with the head elevated may also have short-term therapeutic effects. For severe orthostatic hypotension caused by spinal cord injury or autonomic nervous system failure, applying a compression bandage or elastic bandage to the abdomen or lower limbs for a short period of 30–60 mmHg before standing, body counter-movements (increasing muscle tension in the upper and lower limbs), or functional electrical stimulation of the lower limb muscles may have some therapeutic effect.

How should antihypertensive medications be taken when a hypertensive patient experiences orthostatic hypotension?

Hypertension combined with orthostatic hypotension poses a greater risk to patients. On the one hand, hypertension damages target organs; on the other hand, excessively low blood pressure leads to insufficient organ perfusion. The coexistence of hypertension and hypotension creates a treatment dilemma. For these patients, the treatment goal for orthostatic hypotension is to alleviate symptoms as much as possible, correct the underlying cause, restore autonomic nerve function, and reduce complications.

Recommendations for patients with hypertension and orthostatic hypotension:

1. Antihypertensive medications should be started at a low dose, gradually increasing the dose every 1-2 weeks, while closely monitoring orthostatic blood pressure.

2. The dosage of antihypertensive medication can be reduced.

3. ACE inhibitors or ARBs, which can effectively regulate blood pressure and increase cardiac and cerebral perfusion, should be given priority.

4. Antihypertensive medications that easily cause orthostatic hypotension should be used with caution, such as alpha-blockers, hydralazine, reserpine, beta-blockers, and diuretics such as indapamide.

Note: If a patient has hypertension and orthostatic hypotension, adjustments to antihypertensive medications should be made according to the doctor's instructions. Self-adjustment or discontinuation of medication is strictly prohibited. The second scenario: Postprandial hypotension

It is generally defined as a decrease in systolic blood pressure of ≥20 mmHg within 2 hours after a meal compared to pre-meal levels; or a pre-meal systolic blood pressure ≥100 mmHg but post-meal <90 mmHg; or the appearance of postprandial symptoms of cerebral and cardiac ischemia (angina, dizziness, syncope, etc.). The incidence of postprandial hypotension in the Chinese population is 59.3%, and in hospitalized elderly patients, it ranges from 61.6% to 74.1%. The incidence of postprandial hypotension is much higher than that of orthostatic hypotension, and it increases with age, being more common in hypertensive patients. The highest incidence of hypotension occurs after breakfast, with a significantly greater decrease in blood pressure after breakfast or lunch than after dinner. Postprandial systolic blood pressure typically decreases by 20–40 mmHg, but in severe cases, it can reach 90 mmHg. Furthermore, the higher the pre-meal blood pressure, the higher the incidence and the greater the decrease in blood pressure during postprandial hypotension.

What are the symptoms of postprandial hypotension?

The symptoms of postprandial hypotension usually occur 30 to 60 minutes after a meal. Common symptoms include drowsiness, weakness, dizziness, blurred vision, and fainting. In severe cases, it can lead to falls, speech impairment, visual disturbances, transient ischemic attacks, and even angina.