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L'ipertensione postprandiale. Un fattore di rischio trascurato?

L'ipertensione arteriosa è universalmente riconosciuta come un importante fattore di rischio per le malattie cardiovascolari. Meno noto è il ruolo della variabilità della pressione, sia come riduzione, sia come aumento transitorio. All'ipotensione ortostatica, ma anche a quella meno nota che si verifica nel periodo postprandiale, alcuni studi attribuiscono un aumento del rischio di morte, di danno cerebrale asintomatico o di un vero e proprio ictus, soprattutto nei pazienti anziani. Sia in ortostatismo, sia nel periodo postprandiale, la pressione può anche aumentare e l'ipertensione transitoria che si verifica in queste occasioni potrebbe essere associata ad un aumentato rischio cardiovascolare. E' quanto suggeriscono Uetani e Coll. che hanno dimostrato che i pazienti anziani che mostrano un aumento della pressione arteriosa nel periodo postprandiale (almeno 10 mmHg) hanno più aterosclerosi, misurata come spessore medio-intimale della carotide, di quelli che hanno ipotensione o di quelli che non mostrano variazioni della pressione arteriosa.

Postprandial hypertension, an overlooked risk marker for arteriosclerosis

Uetani E, Tabara Y, Igase M, Guo H, Kido T, Ochi N, Takita R, Kohara K, Miki T

Atherosclerosis 2012;224:500-505

OBJECTIVE: Increased blood pressure (BP) variability is suggested to be a risk factor for cardiovascular disease. Although a postprandial decline in BP is a frequently observed phenomenon in the elderly, little attention has been paid to the clinical and diagnostic significance of postprandial BP change. Here, we aimed to clarify the possible association between postprandial BP dysregulation and arteriosclerosis.
METHODS: The study subjects were 1339 apparently healthy middle-aged to elderly persons (66 ± 9 years old). Postprandial changes in BP were calculated by two readings on the same day, one just before lunch with a standardized Japanese meal and the second 30 min after lunch. Arteriosclerosis was assessed by carotid intima-media thickness and brachial-to-ankle pulse wave velocity.
RESULTS: Mean preprandial and postprandial systolic BP was 127 ± 18 and 123 ± 18 mmHg respectively. One hundred and twelve subjects (8.4%) showed a greater than 20-mmHg postprandial decline in systolic BP, while 129 (9.6%) showed a greater than 10-mmHg increase. Arteriosclerosis was significantly higher in both postprandial hypotensive and hypertensive subjects. The postprandial changes in systolic BP were strongly associated with preprandial systolic BP (r = 0.335, p < 0.001). The association between postprandial hypotension and increased arteriosclerosis was therefore lost after adjustment for basal systolic BP. Multiple linear regression analysis adjusted for possible covariates, including basal BP, identified a postprandial increase in BP as an independent determinant of insulin resistance as assessed by HOMA-IR (ß = 0.093, p < 0.001), carotid thickness (ß = 0.086, p = 0.001) and pulse wave velocity (ß = 0.170, p < 0.001).
CONCLUSION: Postprandial increase in BP is a novel risk marker for arteriosclerosis.

Atherosclerosis 2012;224:500-505