Postprandial hypotension is a common disorder of blood pressure regulation in the elderly, associated with falls and syncope. The pathophysiological mechanism is thought to be related to impaired vascular compensation for splanchnic blood pooling after a meal.
Several studies have suggested that caffeine, acarbose, and Guar gum can improve reduction of postprandial blood pressure (BP). However, these treatments may not necessarily be effective in the patients with symptomatic PPH.
Recently, we first experienced the effect of Theophylline on PPH which categorized as xanthine like caffeine. In this study, we investigated the mechanism of action of Theophylline.
Design and method:
The case is an 92-year-old man under outpatient care for hypertension was admitted to Aoyama Hospital, Tokyo Women's Medical University, Tokyo, Japan, for the investigation and treatment of faintness after breakfast in December 2014. Ambulatory BP monitoring (ABPM) over a 24 hours period showed a decrease in systolic BP of more than 20 mmHg within 2 hours after meal, leading to the diagnosis of PPH.
We performed meal test during two days hospitalization. Measurement items were blood pressure, blood test including plasma levels of glucose, insulin, noradrenaline (NA) and renin activity (PRA) before and after breakfast. At the first day, we tested in control (without Theopylline). Next day, we evaluate the effects of Theopylline on PPH. Four hundred mg of Theopylline was given at once before going to sleep at the first day
In control, the systolic blood pressure (SBP) decreased from 134mmHg to 97mmHg at 90 minutes after eating. Surprisingly, Theophylline maintained to the drop of SBP from 114mmHg to 97mmHg.
Serum NA and PRA levels showed marked elevation under Theophylline administration.
Moreover, after taking Theophylline, the patient's symptoms had disappeared
We report a case of postprandial hypotension improved by theophylline administration. The part of mechanism may involve the effects of Theopylline as an Adenosine receptor antagonist.