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Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy

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Abstract

Postprandial hypotension (PPH) is a major clinical problem in patients with autonomic failure such as that observed in multiple system atrophy (MSA). The pathophysiology of PPH remains unclear, although autonomic dysfunction and gastrointestinal vasoactive peptides have been suspected to participate in its pathogenesis. We measured blood pressure and plasma levels of glucose, insulin, noradrenaline, neurotensin, glucagon-like peptide (GLP)-1 and GLP-2 before and after meal ingestion in 24 patients with MSA to reveal the roles of the autonomic nervous system and gastrointestinal vasoactive peptides in PPH. We performed a second meal-ingestion test by administering acarbose to evaluate the effects of acarbose (an α-glucosidase inhibitor) on PPH and vasoactive peptides in 14 patients with MSA and PPH. We also evaluated blood pressure responses to the head-up tilt test and heart rate variability in all the patients. Severities of PPH and orthostatic hypotension were significantly correlated. Patients with PPH had significantly worse orthostatic hypotension and lower heart rate variability than those without PPH. Postprandial GLP-1 secretion was higher in patients with PPH than in those without PPH. No significant differences were observed in the postprandial increases in plasma levels of glucose, insulin, noradrenaline, neurotensin or GLP-2. Acarbose significantly attenuated postprandial hypotension and tended to decrease GLP-2 secretion. Our results indicate that autonomic failure is involved in the pathogenesis of PPH and confirm that acarbose has a preventive effect against PPH in patients with MSA. Decreased postprandial secretion of GLP-2, which increases intestinal blood pooling, may attenuate PPH in patients with MSA.

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Acknowledgement

We would like to express gratitude to Dr. Yasunori Sato who provided valuable statistical analysis advice.

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None.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Neurology, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Takeshi Fukushima, Masato Asahina, Yoshikatsu Fujinuma, Yoshitaka Yamanaka, Akira Katagiri, Masahiro Mori & Satoshi Kuwabara

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  1. Takeshi Fukushima
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  2. Masato Asahina
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  3. Yoshikatsu Fujinuma
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  4. Yoshitaka Yamanaka
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  7. Satoshi Kuwabara
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Correspondence to Masato Asahina.

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Fukushima, T., Asahina, M., Fujinuma, Y. et al. Role of intestinal peptides and the autonomic nervous system in postprandial hypotension in patients with multiple system atrophy. J Neurol 260, 475–483 (2013). https://doi.org/10.1007/s00415-012-6660-x

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  • DOI: https://doi.org/10.1007/s00415-012-6660-x

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