Postprandial hypotension is associated with increased blood pressure variability in patients with type 2 diabetes

Postprandial hypotension (PPH), which is associated with adverse cardiovascular outcomes, is a prevalent but often overlooked in individuals with type 2 diabetes mellitus (T2DM). In addition, its relationship with comprehensive 24-hour hemodynamic profiles remains poorly defined. We aimed to assess the prevalence and characteristics of PPH in patients with T2DM and to determine its association with systolic blood pressure (SBP) variability and circadian blood pressure (BP) patterns.

We prospectively enrolled T2DM patients with stable glycemic control. PPH was defined as a post-meal SBP fall of ≥ 20 mmHg or a drop to < 90 mmHg within 2 hours after a meal. Hemodynamic patterns, including SBP variability (standard deviation) and circadian rhythms, were analyzed via 24-hour ambulatory BP monitoring.

We analyzed 67 T2DM patients (59.2 ± 11.9 years, 33 females). PPH was observed in 28 patients (41.8%). PPH occurred most frequently after dinner (64.3%), and less frequently after breakfast (25.9%). While average 24-hour BP levels were similar between groups, the PPH group exhibited significantly higher 24-hour SBP variability (21.4 ± 5.7 vs. 16.2 ± 4.3, P < 0.001) and a higher prevalence of morning surge (53.6% vs. 25.6%, P = 0.024). Multivariate logistic regression revealed that 24-hour SBP variability was the sole independent predictor of PPH (odds ratio, 1.211; 95% confidence interval, 1.043-1.406; P = 0.012).

In our cohort, PPH was found in 41.8% of patients with T2DM and was independently associated with increased SBP variability. These results suggest that BP variability could be a valuable marker for identifying individuals at higher risk for postprandial hemodynamic instability.