Pharmacological treatment of postprandial reductions in blood pressure: a systematic review

Abstract

Objectives: To systematically review the current literature on the pharmacological treatment of postmeal reductions in blood pressure (BP).

Design: A systematic literature search and standardized data collection of randomized controlled trials on the pharmacological prevention of postprandial reductions in BP in adults using MEDLINE (1950-), EMBASE (1980-), and CINAHL databases was conducted up to July 2013. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies.

Setting: Systematic review of randomized controlled trials using PRISMA guidelines.

Measurements: Articles were assessed using the Critical Appraisal Skills Programme for randomized controlled trials.

Results: Thirteen articles reporting 12 studies (1 study was reported in 2 articles) demonstrated that caffeine (5 studies); acarbose; 3,4-DL-threo-dihydroxyphenylserine; guar gum (3 studies); and octreotide (2 studies) statistically attenuated the postprandial reduction in BP. One caffeine study did not show this. Most studies did not include individuals with symptomatic postprandial hypotension (PPH), so interpretation and application of these findings to this patient group should be made with caution. For symptomatic participants, there was improvement with acarbose but none with caffeine. Differences in the way the data were presented in the studies did not allow for quantification of treatment effects using meta-analysis.

Conclusion: Drug interventions can attenuate postprandial reductions in BP, but they may not necessarily be effective in people with symptomatic PPH.

Keywords: drug treatment; pharmacological treatment; postprandial hypotension.