Postprandial hypotension (PPH) is an important and frequent problem, particularly in the elderly. Several studies have suggested that caffeine, acarbose, DL-DOPS, Guar gum and octreotide can improve postprandial symptoms and result in reduction in postprandial blood pressure (BP). However, these treatments may not necessarily be effective in the patients with symptomatic PPH.
In the present study, we sought to determine whether Theophylline, an adenosine antagonist same as caffeine could be effective for PPH showing resistance to other treatments.
Design and method:
The first case, a 74-year-old man under outpatient care for hypertension was admitted to our hospital for the treatment of syncope after breakfast in June 2014. Ambulatory BP monitoring (ABPM) over a 24 hours period showed a decrease in systolic BP of more than 20 mmHg after meal, leading to the diagnosis of PPH. We performed meal test using ABPM. We investigated and compared the effects of voglibose (0.6 mg/day), Guar gum, and Theophylline (400 mg/day) by ABPM.
We examined the same meal test to the other patients, a 75-year-old man for the treatment of faintness after breakfast in September 2014, and a 92-year-old man with faintness after breakfast in December 2014.
In the first patient, in control, BP decreased from 149/63 to 85/46mmHg after eating. Similar results were observed with administration of voglibose and Guar gum (BP: from 121/79 to 74/51mmHg, from 121/63 to 89/55mmHg, respectively). Surprisingly, Theophylline maintained the drop of BP from 124/68 to 117/68mmHg.
In the second patient, the same result was obtained. BP was decreased from 121/63mmHg to 90/56mmHg after eating. However, teophylline treatment resulted in a smaller reduction in BP (BP from 118/47 to 113/60mmHg)
In the third patient, the same result was obtained. BP was decreased from 134/77mmHg to 97/57mmHg However, in teophylline treatment showed BP from 114/64 to 97/58mmHg.
We report three cases of postprandial hypotension which was corrected by theophylline administration.
It is suggested that Theophylline may be an alternative effective treatment for symptomatic postprandial hypotension in the elderly.