Postprandial hypotension in older people receiving tube feeding through gastrostomy

Postprandial hypotension (PPH) is recognized as a clinical problem, constituting a potential risk for cerebral and cardiovascular events, as well as mortality. The present study was designed to test the hypothesis that PPH is prevented by slowing the infusion rate of enteral nutrition through tube feeding and by avoiding the administration of antihypertensive drugs just before the start of tube feeding.

Participants were older people receiving tube feeding through gastrostomy who used a geriatric health services facility (n = 12; mean age 79.8 years). Changes in blood pressure during and after enteric nutrient infusion lasting for 1 or 2 h were investigated with or without the administration of antihypertensive drugs just before the start of tube feeding.

When enteric nutrient was infused for 1 h, after the administration of antihypertensive drugs, nine of 12 participants showed PPH with a maximal reduction in systolic blood pressure of 37.6 ± 6.5 mmHg. Although PPH was not prevented by avoiding drug administration before infusion (maximal blood pressure reduction 30.2 ± 5.0 mmHg) or by extending the infusion time to 2 h (26.5 ± 7.5 mmHg), the combination of the two actions prevented PPH and reduced the postprandial fall in systolic blood pressure to 17.6 ± 5.8 mmHg.

The prevalence of PPH in older people receiving tube feeding was 75%. Slowing the enteric nutrient infusion rate combined with avoiding antihypertensive drugs just before the infusion was useful for preventing PPH. Geriatr Gerontol Int 2018; 18: 1474-1478.