Abstract
Postprandial hypotension was studied in 17 hemodialysis patients not being treated with antihypertensive drugs. Blood pressure (BP) was measured at intervals of 2 minutes with a non-invasive automatic ambulatory BP recorder (ABPM630, Japan Colin, Tokyo) in the sitting position from 30 minutes before lunch until 60 minutes after lunch.
The characteristics of postprandial blood pressure variation were classified into 3 types: (1) continuously lower type, in which BP after lunch was continuously significantly lower than BP before lunch (p<0.01), (2) transiently lower type, in which BP after lunch was transiently significantly lower than BP before lunch (p<0.01), and (3) other (non-lower) type, in which BP after lunch was not significantly lower than BP before lunch (p<0.01). The Shellong test and CV% of the R-R interval on the ECG were also assessed.
Four patients were classified as the continuously lower type, and 4 as the transiently lower type. Those with the transiently lower type consisted of 3 patients with chronic glomerulonephritis and 1 with chronic pyelonephritis. Those with the continuously lower type consisted of 2 patients with diabetic nephropathy and 2 with chronic glomerulonephritis associated with diabetes mellitus. The 2 diabetic nephropathy patients had a 20-and 22-years history of diabetes, respectively. The duration of diabetes mellitus in the 2 chronic glomerulonephritis patients with diabetes mellitus were 7 and 8 years, respectively. All patients with the continuously lower type had diabetes mellitus. On the other hand 4 of the 6 patients with diabetes mellitus exhibited the continuously lower type.
These findings suggest that more attention should be paid to postprandial hypotension in the blood pressure management of hemodialysis patients, especially diabetic patients.
