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Acarbose, an alpha-glucosidase inhibitor, attenuates postprandial hypotension in autonomic failure.
Hypertension. 2007 Jul; 50(1):54-61.H

Abstract

Postprandial hypotension is an important clinical condition that predisposes to syncope, falls, angina, and cerebrovascular events. The magnitude of the fall in blood pressure after meals depends on enteric glucose availability. We hypothesized that acarbose, an alpha-glucosidase inhibitor that decreases glucose absorption in the small intestine, would attenuate postprandial hypotension. Acarbose or placebo was given 20 minutes before a standardized meal in 13 patients with postprandial hypotension in the setting of autonomic failure (age: 65+/-2.64 years; body mass index: 25+/-1.08 kg/m(2); supine plasma norepinephrine: 110+/-26.6 pg/mL). Four patients were studied in a single-blind protocol and 9 patients in a double-blind, randomized, crossover fashion. Patients were studied supine, and blood pressure, heart rate, and neuroendocrine parameters were obtained at baseline and for 90 minutes after meal intake. After adjusting for potential confounders, acarbose significantly attenuated the postprandial fall in systolic and diastolic blood pressures by 17 mm Hg (95% CI: 7 to 28; P=0.003) and 9 mm Hg (95% CI: 5 to 14; P=0.001), respectively. Furthermore, acarbose effectively reduced plasma levels of insulin, a known vasodilator, by 11 microU/mL (95% CI: 5 to 18; P=0.001) compared with placebo. After adjusting for insulin levels, the attenuation of postprandial hypotension by acarbose remained significant, indicating that additional mechanisms contribute to this effect. In conclusion, 100 mg of acarbose successfully improved postprandial hypotension in patients with severe autonomic failure. This effect is not explained solely by a reduction in insulin levels.

Authors+Show Affiliations

Department of Medicine, Division of Clinical Pharmacology and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17515447

Citation

Shibao, Cyndya, et al. "Acarbose, an Alpha-glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure." Hypertension (Dallas, Tex. : 1979), vol. 50, no. 1, 2007, pp. 54-61.
Shibao C, Gamboa A, Diedrich A, et al. Acarbose, an alpha-glucosidase inhibitor, attenuates postprandial hypotension in autonomic failure. Hypertension. 2007;50(1):54-61.
Shibao, C., Gamboa, A., Diedrich, A., Dossett, C., Choi, L., Farley, G., & Biaggioni, I. (2007). Acarbose, an alpha-glucosidase inhibitor, attenuates postprandial hypotension in autonomic failure. Hypertension (Dallas, Tex. : 1979), 50(1), 54-61.
Shibao C, et al. Acarbose, an Alpha-glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure. Hypertension. 2007;50(1):54-61. PubMed PMID: 17515447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acarbose, an alpha-glucosidase inhibitor, attenuates postprandial hypotension in autonomic failure. AU - Shibao,Cyndya, AU - Gamboa,Alfredo, AU - Diedrich,Andre, AU - Dossett,Cynthia, AU - Choi,Leena, AU - Farley,Ginnie, AU - Biaggioni,Italo, Y1 - 2007/05/21/ PY - 2007/5/23/pubmed PY - 2007/7/17/medline PY - 2007/5/23/entrez SP - 54 EP - 61 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 50 IS - 1 N2 - Postprandial hypotension is an important clinical condition that predisposes to syncope, falls, angina, and cerebrovascular events. The magnitude of the fall in blood pressure after meals depends on enteric glucose availability. We hypothesized that acarbose, an alpha-glucosidase inhibitor that decreases glucose absorption in the small intestine, would attenuate postprandial hypotension. Acarbose or placebo was given 20 minutes before a standardized meal in 13 patients with postprandial hypotension in the setting of autonomic failure (age: 65+/-2.64 years; body mass index: 25+/-1.08 kg/m(2); supine plasma norepinephrine: 110+/-26.6 pg/mL). Four patients were studied in a single-blind protocol and 9 patients in a double-blind, randomized, crossover fashion. Patients were studied supine, and blood pressure, heart rate, and neuroendocrine parameters were obtained at baseline and for 90 minutes after meal intake. After adjusting for potential confounders, acarbose significantly attenuated the postprandial fall in systolic and diastolic blood pressures by 17 mm Hg (95% CI: 7 to 28; P=0.003) and 9 mm Hg (95% CI: 5 to 14; P=0.001), respectively. Furthermore, acarbose effectively reduced plasma levels of insulin, a known vasodilator, by 11 microU/mL (95% CI: 5 to 18; P=0.001) compared with placebo. After adjusting for insulin levels, the attenuation of postprandial hypotension by acarbose remained significant, indicating that additional mechanisms contribute to this effect. In conclusion, 100 mg of acarbose successfully improved postprandial hypotension in patients with severe autonomic failure. This effect is not explained solely by a reduction in insulin levels. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/17515447/Acarbose_an_alpha_glucosidase_inhibitor_attenuates_postprandial_hypotension_in_autonomic_failure_ L2 - https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.107.091355?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -