Postprandial Hypotension

What is postprandial hypotension?

Postprandial hypotension is a large drop in blood pressure up to two hours after you eat a meal. Normally, your heart rate goes up after eating so your digestive system has enough blood to digest your food. Meanwhile, other blood vessels in your body tighten (constrict) to keep your blood pressure at a normal level. A drop in blood pressure can happen if your heart rate doesn’t go up enough and your blood vessels don’t tighten as much as they should.

A big drop in blood pressure can leave you feeling dizzy or sick after eating, which isn’t normal. You should look forward to eating instead of dreading it because of how you might feel afterward. But treatments for postprandial hypotension can help you enjoy eating again.

How common is postprandial hypotension?

Postprandial hypotension is common among older people. A review of multiple studies showed that about 40% of people between age 65 and 86 have postprandial hypotension.

What are the symptoms?

Many people don’t have symptoms. But for those who do, they tend to be worse in the morning. Postprandial hypotension symptoms include:

• Dizziness.
• Lightheadedness.
• Fainting.
• Weakness.
• Fatigue.
• Angina (chest pain).
• Nausea.
• Black spots in your field of vision.

What causes postprandial hypotension?

As people age and their arteries stiffen, they may have a harder time adjusting to factors that affect their blood pressure. (Arteries change your blood pressure by getting wider or narrower.) Postprandial hypotension causes include:

• Eating large meals.
• Not eating enough salt.
• Being dehydrated from not drinking enough fluid.
• Being in hot weather.

What are the risk factors for postprandial hypotension?

Your risk of postprandial hypotension is higher if you:

• Are 65 or older.
• Have high blood pressure.
• Have Parkinson’s disease.
• Have diabetes.
• Have heart failure.
• Have end-stage kidney disease.
• Have multiple system atrophy.
• Are more likely to have it because of your genes.

What are the complications of postprandial hypotension?

People who are dizzy from postprandial hypotension may fall. They may also have a higher risk of transient ischemic attacks (TIAs) and cerebrovascular disease.

How is postprandial hypotension diagnosed?

A provider will talk with you about your health history and the timing of your symptoms. They’ll take your blood pressure before you eat and then again after you eat. With postprandial hypotension, your top blood pressure number drops about 20 millimeters of mercury after eating. For most people with the condition, their blood pressure drops within 30 to 60 minutes of eating.

What tests will be done to diagnose postprandial hypotension?

You may need ambulatory blood pressure monitoring for 24 hours to confirm that you have this condition. These check your blood pressure every 10 to 15 minutes.

How is postprandial hypotension treated?

Postprandial hypotension treatment consists of things you can do at home, like:

• Lying down after you eat a meal.
• Not taking blood pressure medicines before eating. (Check with your provider first.)
• Taking blood pressure medicines later in the day. (Check with your provider first.)
• Eating smaller, more frequent meals (six instead of three).
• Eating meals that are low in carbohydrates.
• Drinking 350 to 480 mL (12 to 16 ounces) of water before a meal.
• Walking for 10 minutes after you eat.
• Drinking a beverage with caffeine before breakfast or lunch.
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) before eating. (Check with your provider first.)

Medications to treat postprandial hypotension

A provider may prescribe acarbose to take only when you eat meals that have a lot of carbohydrates. If you have severe symptoms, you may receive octreotide injections in the hospital. This allows less blood to go to your digestive system, making more blood available to the rest of your body.

Side effects of the treatment

Acarbose can cause gas and loose stools (poop). Octreotide can cause belly pain, nausea and vomiting.

How can I lower my risk of postprandial hypotension?

You may be able to lower your risk of postprandial hypotension by eating smaller meals more often. Meals that are low in carbohydrates may help, too. Acarbose medication may prevent the condition.

What can I expect if I have postprandial hypotension?

Postprandial hypotension can be dangerous if you fall and get hurt when you faint. But many at-home treatments can help. If those don’t work, talk with your provider about medicines they can prescribe.

How do I take care of myself?

In caring for yourself, following the suggested at-home treatments is a good start. Talk to your provider about which treatments are most likely to help you.

When should I see my healthcare provider?

Regular follow-up appointments with your provider will help them see how well the home treatments are working for you. They can prescribe medication for you if you need it.

When should I go to the ER?

Get emergency medical care if you fall and have a serious injury after fainting. A provider should examine you even if you don’t have any obvious bleeding. You could have bleeding inside your body that you can’t see.

What questions should I ask my healthcare provider?

Questions you may want to ask your provider include:

• What’s the best change to my eating routine to try first?
• Should I take my blood pressure medicine later in the day?
• How many cups of coffee or tea can I have in the morning?
• What kinds of foods should I eat (or avoid) to limit the amount of carbohydrates I eat?

A note from Cleveland Clinic

Changing your meal schedule might take some getting used to. But at least it’s something that’s in your control. You can freeze small portions of what you normally cook so you don’t have to cook more often. Adjusting when and how much you eat can pay off if it makes you feel steadier after eating.