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(Hypertension. 2007;50:54.)
© 2007 American Heart Association, Inc.

Original Articles

Acarbose, an -Glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure

Cyndya Shibao; Alfredo Gamboa; Andre Diedrich; Cynthia Dossett; Leena Choi; Ginnie Farley; Italo Biaggioni

From the Department of Medicine, Division of Clinical Pharmacology and the Autonomic Dysfunction Center (C.S., A.G., A.D., G.F., I.B.), General Clinical Research Center (C.D.), and the Department of Biostatistics (L.C.), Vanderbilt University School of Medicine, Nashville, Tenn.

Correspondence to Italo Biaggioni, 1500 21st Ave South, Suite 3500, Clinical Trials Center, Vanderbilt University, Nashville, TN 37212. E-mail Italo.biaggioni{at}vanderbilt.edu

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 -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/m²; 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 µU/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.

Key Words: postprandial • hypotension • acarbose • -glucosidase inhibitor • autonomic nervous system diseases • autonomic failure

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				D. Gentilcore, M. Horowitz, and K. L. Jones Acarbose and Postprandial Hypotension Hypertension, November 1, 2007; 50(5): e159 - e159. [Full Text] [PDF]