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Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy.
J Neurol. 2013 Feb; 260(2):475-83.JN

Abstract

Postprandial hypotension (PPH) is a major clinical problem in patients with autonomic failure such as that observed in multiple system atrophy (MSA). The pathophysiology of PPH remains unclear, although autonomic dysfunction and gastrointestinal vasoactive peptides have been suspected to participate in its pathogenesis. We measured blood pressure and plasma levels of glucose, insulin, noradrenaline, neurotensin, glucagon-like peptide (GLP)-1 and GLP-2 before and after meal ingestion in 24 patients with MSA to reveal the roles of the autonomic nervous system and gastrointestinal vasoactive peptides in PPH. We performed a second meal-ingestion test by administering acarbose to evaluate the effects of acarbose (an α-glucosidase inhibitor) on PPH and vasoactive peptides in 14 patients with MSA and PPH. We also evaluated blood pressure responses to the head-up tilt test and heart rate variability in all the patients. Severities of PPH and orthostatic hypotension were significantly correlated. Patients with PPH had significantly worse orthostatic hypotension and lower heart rate variability than those without PPH. Postprandial GLP-1 secretion was higher in patients with PPH than in those without PPH. No significant differences were observed in the postprandial increases in plasma levels of glucose, insulin, noradrenaline, neurotensin or GLP-2. Acarbose significantly attenuated postprandial hypotension and tended to decrease GLP-2 secretion. Our results indicate that autonomic failure is involved in the pathogenesis of PPH and confirm that acarbose has a preventive effect against PPH in patients with MSA. Decreased postprandial secretion of GLP-2, which increases intestinal blood pooling, may attenuate PPH in patients with MSA.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Fukushima T
Department of Neurology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Asahina M
No affiliation info available
Fujinuma Y
No affiliation info available
Yamanaka Y
No affiliation info available
Katagiri A
No affiliation info available
Mori M
No affiliation info available
Kuwabara S
No affiliation info available

MeSH

AcarboseAgedAnalysis of VarianceAutonomic Nervous System DiseasesBlood GlucoseBlood PressureFemaleGlucagon-Like Peptide 1Glucagon-Like Peptide 2HumansHypoglycemic AgentsHypotensionInsulinMaleMiddle AgedMultiple System AtrophyNeurotensinPostprandial Period

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22983428

Citation

Fukushima, Takeshi, et al. "Role of Intestinal Peptides and the Autonomic Nervous System in Postprandial Hypotension in Patients With Multiple System Atrophy." Journal of Neurology, vol. 260, no. 2, 2013, pp. 475-83.
Fukushima T, Asahina M, Fujinuma Y, et al. Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy. J Neurol. 2013;260(2):475-83.
Fukushima, T., Asahina, M., Fujinuma, Y., Yamanaka, Y., Katagiri, A., Mori, M., & Kuwabara, S. (2013). Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy. Journal of Neurology, 260(2), 475-83. https://doi.org/10.1007/s00415-012-6660-x
Fukushima T, et al. Role of Intestinal Peptides and the Autonomic Nervous System in Postprandial Hypotension in Patients With Multiple System Atrophy. J Neurol. 2013;260(2):475-83. PubMed PMID: 22983428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy. AU - Fukushima,Takeshi, AU - Asahina,Masato, AU - Fujinuma,Yoshikatsu, AU - Yamanaka,Yoshitaka, AU - Katagiri,Akira, AU - Mori,Masahiro, AU - Kuwabara,Satoshi, Y1 - 2012/09/15/ PY - 2012/03/25/received PY - 2012/08/17/accepted PY - 2012/08/14/revised PY - 2012/9/18/entrez PY - 2012/9/18/pubmed PY - 2013/9/5/medline SP - 475 EP - 83 JF - Journal of neurology JO - J Neurol VL - 260 IS - 2 N2 - Postprandial hypotension (PPH) is a major clinical problem in patients with autonomic failure such as that observed in multiple system atrophy (MSA). The pathophysiology of PPH remains unclear, although autonomic dysfunction and gastrointestinal vasoactive peptides have been suspected to participate in its pathogenesis. We measured blood pressure and plasma levels of glucose, insulin, noradrenaline, neurotensin, glucagon-like peptide (GLP)-1 and GLP-2 before and after meal ingestion in 24 patients with MSA to reveal the roles of the autonomic nervous system and gastrointestinal vasoactive peptides in PPH. We performed a second meal-ingestion test by administering acarbose to evaluate the effects of acarbose (an α-glucosidase inhibitor) on PPH and vasoactive peptides in 14 patients with MSA and PPH. We also evaluated blood pressure responses to the head-up tilt test and heart rate variability in all the patients. Severities of PPH and orthostatic hypotension were significantly correlated. Patients with PPH had significantly worse orthostatic hypotension and lower heart rate variability than those without PPH. Postprandial GLP-1 secretion was higher in patients with PPH than in those without PPH. No significant differences were observed in the postprandial increases in plasma levels of glucose, insulin, noradrenaline, neurotensin or GLP-2. Acarbose significantly attenuated postprandial hypotension and tended to decrease GLP-2 secretion. Our results indicate that autonomic failure is involved in the pathogenesis of PPH and confirm that acarbose has a preventive effect against PPH in patients with MSA. Decreased postprandial secretion of GLP-2, which increases intestinal blood pooling, may attenuate PPH in patients with MSA. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/22983428/Role_of_intestinal_peptides_and_the_autonomic_nervous_system_in_postprandial_hypotension_in_patients_with_multiple_system_atrophy_ L2 - https://dx.doi.org/10.1007/s00415-012-6660-x DB - PRIME DP - Unbound Medicine ER -