avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2024-14-4-245-250LPBEKWavk-1819Research ArticleЛЕКЦИИLECTURESПостпрандиальная гипотензия у пожилых пациентов: патофизиология, диагностика и меры профилактикиPostprandial Hypotension in Elderly Patients: Pathophysiology, Diagnosis and Prevention Measureshttps://orcid.org/0000-0002-6233-7202АнтроповаО. Н.AntropovaO. N.

Антропова Оксана Николаевна — д.м.н., профессор кафедры факультетской терапии и профессиональных болезней

Барнаул

Oksana N. Antropova — Doctor of Medical Sciences, Professor of the Department of Faculty Therapy and Occupational Diseases

Barnaul

antropovaon@mail.ruhttps://orcid.org/0000-0003-4688-0739ЕфремушкинаА. А.EfremushkinaA. A.

Ефремушкина Анна Александровна — д.м.н., профессор кафедры терапии и общей врачебной практики с курсом ДПО

Барнаул

Anna A. Efremushkina — Doctor of Medical Sciences, Professor of the Department of Therapy and General Medical Practice with a course of additional vocational training

Barnaul

sunsun3@yandex.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияAltai State Medical UniversityRussian Federation202430072024144245250Copyright © Антропова О.Н., Ефремушкина А.А., 20242024Антропова О.Н., Ефремушкина А.А.Antropova O.N., Efremushkina A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1819

Постпрандиальная гипотензия (ППГ) является важным, но недостаточно распознаваемым состоянием, возникающим в результате неадекватной компенсаторной реакции сердечно-сосудистой системы на индуцированное приемом пищи висцера льное скопление крови. ППГ признана важной клинической проблемой поскольку имеет высокую распространенность в популяции старшей возрастной группы и связана с развитием сердечно-сосудистых осложнений и гериатрических синдромов. Возможные патофизиологические механизмы ППГ: повышенный висцеральный кровоток; ослабление барорефлекторной функции из-за нарушений, связанных с возрастом или вегетативной дисфункцией; неадекватная активация симпатических нервов; нарушение регуляции вазоактивных кишечных пептидов; инсулин-опосредованная вазодилатация. Опрос о симптомах гипотонии после приема пищи и снижение систолического артериального давления (АД) на ≥20 мм рт. ст. через 15- 60 минут после еды имеет первостепенное значение для постановки диагноза ППГ. Одной из основных стратегий профилактики ППГ является снижение растяжения желудка (небольшие порции пищи и более частое питание), отдых лежа на спине после еды, употребление достаточного количества воды. Ходьба после приема пищи, по-видимому, также помогает восстановить АД после еды. Необходимо проявлять осторожность при назначении белковых добавок у пожилых людей, модификацировать диету путем замены высокопитательных подсластителей низкокалорийными (d-ксилоза, ксилит, эритрит, мальтоза, мальтодекстрин и тагатоза). Метформин или акарбоза модулируют сердечно-сосудистую реакцию у пациентов с сахарным диабетом, уменьшают постпрандиальную гипотензию. Таким образом, ППГ является достаточно распространенным и клинически значимым феноменом у пожилых больных. Повышение информированности врачей о патофизиологии и методах диагностики, профилактики позволит повысить эффективность и безопасность ведения гериатрических пациентов.

Postprandial hypotension (PPH) is an important but underrecognized condition resulting from an inadequate compensatory cardiovascular response to meal-induced visceral blood pooling. PPG is recognized as an important clinical problem because it has a high prevalence in the older age group and is associated with the development of cardiovascular complications and geriatric syndromes. Possible pathophysiological mechanisms of PPG: increased visceral blood flow; weakening of baroreflex function due to disorders associated with age or autonomic dysfunction; inappropriate activation of sympathetic nerves; dysregulation of vasoactive intestinal peptides; insulin-mediated vasodilation. Ask about symptoms of postprandial hypotension and a decrease in systolic blood pressure (BP) of ≥20 mm Hg. Art. 15-60 minutes after eating is of paramount importance for making a diagnosis of PPG. One of the main strategies for preventing PPG is to reduce gastric distension (small meals and more frequent meals), resting on your back after eating, and drinking enough water. Walking after eating also appears to help restore blood pressure after eating. Caution should be exercised when prescribing protein supplements in the elderly, modifying the diet by replacing high-nutrient sweeteners with low-calorie sweeteners (d-xylose, xylitol, erythritol, maltose, maltodextrin, and tagatose). Metformin or acarbose modulates the cardiovascular response in patients with diabetes mellitus and reduces postprandial hypotension. Thus, PPG is a fairly common and clinically significant phenomenon in elderly patients. Increasing the awareness of doctors about pathophysiology and methods of diagnosis and prevention will improve the efficiency and safety of managing geriatric patients.

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The authors declare that there are no conflicts of interest present.