Acarbose improved severe postprandial hypotension in a patient with diabetes mellitus

Postprandial hypotension (PPH) is defined as a decrease of systolic blood p ressure by more than 20 mmHg after meals. Severe PPH is a troublesome diabe tic complication, which has no established means of treatment. We encounter ed a patient who had diabetes mellitus complicated by severe PPH and attemp ted to treat this problem using several medications (octreotide, midodrine hydrochloride, and acarbose). A 58-year-old male with diabetic triopathy co mplained of orthostatic dizziness and vertigo after meals. The blood pressu re was monitored for 24 h with an ambulatory blood pressure monitor, reveal ing that the systolic blood pressure decreased markedly after breakfast and dinner by 45 and 50 mmHg, respectively. PPH was not improved by a subcutan eous injection of octreotide. Administration of midodrine hydrochloride red uced the frequency of hypotensive episodes from twice to once daily, but th e magnitude of the postprandial fall in blood pressure was still around 30 mmHg. After the patient started to receive acarbose therapy, the postprandi al fall in blood pressure was diminished to Is mmHg and his symptoms largel y disappeared. For the treatment of PPH in diabetic patients, our experienc e suggests that it may be appropriate to try first on alpha -glucosidase in hibitor like acarbose. (C) 2001 Elsevier Science Inc. All rights reserved.