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Postprandial hypotension in neurological disorders: systematic review and meta-analysis

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Abstract

Purpose

Postprandial hypotension (PPH) has been associated with increased risk of syncope, falls, stroke, angina and mortality. As the majority of patients with PPH are asymptomatic, the diagnosis is often overlooked. The aim of this study was to perform a systematic review and meta-analysis of available scientific evidence on the likelihood of PPH in neurological diseases.

Methods

A systematic review of the literature (PubMed library, Cochrane Database for Systematic Reviews and Cochrane Central Register of Controlled Trials for results up to January 2017) identified 327 studies, of which 11 reported the frequency of PPH in patients with neurological diseases compared to healthy controls. These 11 studies were on patients with Parkinson’s disease (PD; n = 6 studies), multiple system atrophy (MSA; n = 1), Alzheimer’s disease (AD; n = 1) and diabetic neuropathy (DN; n = 2).

Results

The meta-analysis revealed that patients with neurological diseases had a significantly higher frequency of PPH than healthy controls [147/289 patients vs. 41/217 controls; odd ratio (OR) 5.23, 95% confidence interval (CI) 2.90–9.45, p < 0.00001]. For each of the four diseases, the respective patients had a significantly higher frequency of PPH than healthy controls (PD: 107/201 patients vs. 32/136 controls; OR 3.49, 95% CI 2.09–5.83, p < 0.0001; MSA: 19/27 patients vs. 0/24 controls; OR 89.55, 95% CI 2.65–3030.33, p = 0.01; AD: 7/10 patients vs. 6/23 controls; OR 6.61, 95% CI 1.28–34.14, p = 0.02; DN: 14/51 patients vs. 3/34 controls; OR 4.83, 95%CI 1.20–19.41, p = 0.03).

Conclusion

The likelihood of having PPH is higher in patients with neurological diseases than in healthy controls. These findings should prompt further research focusing on the epidemiology and pathophysiology of PPH in different neurological diseases.

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Authors and Affiliations

  1. School of Medicine, University of Zagreb, Zagreb, Croatia

    Antun Pavelić & Mario Habek

  2. Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Magdalena Krbot Skorić, Luka Crnošija & Mario Habek

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  1. Antun Pavelić
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  2. Magdalena Krbot Skorić
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  3. Luka Crnošija
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  4. Mario Habek
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Correspondence to Mario Habek.

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None of the authors have relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

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Pavelić, A., Krbot Skorić, M., Crnošija, L. et al. Postprandial hypotension in neurological disorders: systematic review and meta-analysis. Clin Auton Res 27, 263–271 (2017). https://doi.org/10.1007/s10286-017-0440-8

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