[Reduction in blood pressure after meals in the elderly. A review article]

It has been known for several years that blood pressure in the elderly may fall after a meal. Although the mechanism is not fully understood, postprandial blood pressure reduction seems to be related to glucose related factors, since blood pressure only falls after oral glucose loading, but not after oral fructose, fat or protein loading. Vasoactive gastrointestinal hormones may play a role in the glucose induced vasodilation of splanchnic vasculature, but attempts to identify such hormones were unsuccessful. Therefore we suggest that interference of insulin with a sympathetic response diminished by age or disease to splanchnic vasodilation, may be responsible for the postprandial fall in blood pressure in the elderly. However, vasodilator effects of insulin or a baroreflex response diminished by insulin do not seem to be involved. Although the clinical significance of postprandial blood pressure reduction remains uncertain, several advises can been given. Treatment of hypertension, small carbohydrate meals, use of caffeine before a meal or treatment with the somatostatin analogue SMS 201-995 may have a beneficial effect.