Postprandial alterations in hemodynamics and blood pressure in normal subjects

doi:10.1016/0002-9149(86)90291-2

The American Journal of Cardiology

Volume 58, Issue 7, 15 September 1986, Pages 636-641

https://doi.org/10.1016/0002-9149(86)90291-2 Get rights and content

Abstract

The effects of a standardized mixed meal, a self-selected meal and a sham meal on heart rate, arterial pressure, cardiac output, total systemic resistance and echocardiographic indexes of left ventricular performance were examined in normal volunteers. Supine heart rate and cardiac output increased after the meals (p < 0.07 to 0.001), but not after the sham meal. Supine diastolic blood pressure and total systemic resistance decreased after the meals but not after the sham meal (p < 0.05 to 0.001). Ejection fraction and mean velocity of circumferential fiber shortening increased after the standard meal (p < 0.01) and tended to increase after the self-selected meal, but did not increase after the sham meal. Meals of normal size may induce splanchnic vasodilation and a decrease in total systemic resistance. Ingestion of food also significantly affects heart rate, blood pressure, cardiac output and echocardiographic indexes of left ventricular performance. Patients should not eat during short-term evaluation of cardiovascular interventions because the cardiovascular effects of a meal may compromise interpretation of the cardiovascular effects of the primary intervention. The hemodyhamic effects of food may also interact with the effects of cardiovascular disease processes.

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Phenotyping Left Ventricular Obstruction With Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy
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The same day of the at-rest and exercise fasting examinations, all patients underwent at-rest re-test PP TTE (PP-TTE) 30 to 60 minutes after a standardized midday meal consisting of a 400 gr “Italian Margherita pizza” with a nutrient composition of approximately 1000 Kcal, including 73% carbohydrates, 18% fats, and 8% proteins. A 30 to 60 minute time period was used, given that previous physiologic studies demonstrate that maximal PP superior mesenteric artery blood low occurs between 20 and 40 minutes after a meal.8,12,18 Brachial blood pressure and ECG monitoring were obtained at the time of PP-TTE examination.
Dynamic left ventricular (LV) obstruction has important clinical and therapeutic implications in patients with hypertrophic cardiomyopathy (HC). Although absent at rest, LV obstruction may be elicited using varying stressors. Meal-related hemodynamic changes may favor LV obstruction and support postprandial (PP) symptoms in HC patients. The aim of this study was to evaluate PP-LV obstruction inducibility in HC patients in comparison with fasting Valsalva maneuver and exercise test. Ninety-two HC patients without LV obstruction underwent at-rest Transthoracic Echocardiography (TTE) during Valsalva maneuver and exercise test under fasting condition followed by at-rest re-test PP-TTE 30 to 60 minutes after a standardized midday meal. LV obstruction was noted and classified as being related to systolic anterior motion (SAM) of the mitral valve (SAM-related) and/or non-SAM-related (mid-cavity or apical), and intraventricular gradient was measured. At-rest re-test PP-TTE showed significant intraventricular gradient (>30 mm Hg) in 68 patients (60 SAM-related, 8 non-SAM related, 30 combined) with a higher prevalence (74%) of HC phenotype re-classified as obstructive compared with the fasting Valsalva maneuver (23%) or exercise test (33%) (p < 0.001). At multivariate analysis, a clinical history of PP symptoms and mitral anterior leaflet length and/or LV outflow ratio >2 were independently correlated with PP-TTE obstruction. In conclusion, PP TTE re-test is a simple and effective approach to unmask latent LV dynamic obstruction in daily clinical practice over fasting Valsalva maneuver or exercise test. PP clinical phenotype refinement may be relevant in targeting and evaluating HC therapy.
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^☆: This study was supported in part by grants NIH-RR1070, NIH-GM0038, NIGMS-07534 and NIGMS-20387 from the National Institutes of Health, Bethesda, Maryland.

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Postprandial alterations in hemodynamics and blood pressure in normal subjects☆

Abstract

Am J Cardiol

Am J Cardiol

Am J Cardiol

Metabolism

Metabolism

Some accounts of a disorder of the breast

Med Trans Coll Phys Lond

Physiological variations in the cardiac output of man III. The effect of the ingestion of food on the cardiac output, pulse rate, blood pressure, and oxygen consumption of man

Am J Physiol

Postprandial reduction in blood pressure in the elderly

N Engl J Med

Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements

Circulation

Acute hypertensive effects of oral and intravenous propranolol: early alterations in peripheral resistance

J Clin Hyperten

Analysis of variance and covariance including repeated measures

Hemodynamic effects of carbohydrate and protein meals in man: rest and exercise

J Appl Physiol

Hemodynamics in early essential hypertension

Acta Med Scand

Systemic and regional hemodynamic changes during food intake and digestion in nonanesthesized dogs

Circ Res

Mesenteric vasoactivity associated with eating and digestion in the conscious dog

Am J Physiol