Effects of variations in duodenal glucose load on blood pressure, heart rate, superior mesenteric artery blood flow and plasma noradrenaline in healthy young and older subjects.

Abstract

PPH (postprandial hypotension), leading to increased morbidity and mortality, is an important clinical problem, particularly in the elderly and individuals with autonomic dysfunction. The magnitude of the postprandial fall in BP (blood pressure) appears to be dependent on the rate of nutrient entry into the small intestine and may be related to changes in splanchnic blood flow and sympathetic nerve activity. We aimed at determining the comparative effects of different ID (intraduodenal) glucose loads on BP, HR (heart rate), SMA (superior mesenteric artery) flow and vascular conductance and plasma NA (noradrenaline) in ‘young’ and ‘older’ subjects. A total of 12 ‘young’ (six male and six female; age, 22.2±2.3 years) and 12 ‘older’ (six male and six female; age, 68.7±1.0 years) subjects, the latter who have been studied previously [Vanis, Gentilcore, Rayner, Wishart, Horowitz, Feinle-Bisset and Jones (2011) Am. J. Physiol. Regul. Integr. Comp. Physiol., 300, R1524–R1531], had measurements of BP, HR, SMA flow and plasma NA before, and during, ID infusions of glucose at 1, 2 or 3 kcal/min (‘G1’, ‘G2’ and ‘G3’) (where 1 kcal≈4.184 J), or ‘S’ (saline) for 60 min. In ‘young’ subjects, there was no change in BP during any of the four infusions. In contrast, in ‘older’ subjects, SBP (systolic BP) fell during ‘G2’, and ‘G3’ (P<0.005 for both), but not during ‘S’ or ‘G1’. In ‘young’ and ‘older’ subjects HR increased during ‘G2’ (P<0.05) and ‘G3’ (P<0.001), a response that was greater (P<0.05) in the young, but not during ‘S’ or ‘G1’. The rise in SMA flow and vascular conductance in response to ID glucose were load-dependent in both ‘young’ and ‘older’ subjects (P<0.001 for all), with no difference between them. Plasma NA rose in response to ‘G2’ and ‘G3’ (P<0.05) in the young, but in ‘G3’ (P<0.05) only in the ‘older’ subjects, with no difference between them. Hence, in response to small intestinal glucose infusions at 1, 2 and 3 kcal/min, ‘older’, but not ‘young’, subjects exhibit a comparable fall in BP in response to the two higher glucose loads, which may reflect an inadequate, compensatory, rise in HR, in the ‘older’ subjects, but not a greater increase in SMA conductance.