Abstract 4368055: Postprandial Hypotension and Blood Pressure Variability in Type 2 Diabetes

Background: Postprandial hypotension (PPH) is a frequent but under-recognized hemodynamic disturbance in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the prevalence and characteristics of PPH and examine its association with blood pressure variability (BPV) and clinical parameters. Methods: We enrolled 121 T2DM patients (mean age 61.1±11.2 years; 50.4% female) who underwent 24-hour ambulatory blood pressure monitoring (ABPM) with annotation of meal times. PPH was defined as a post-meal systolic BP drop ≥20 mmHg. BPV indices included systolic/diastolic standard deviation (SD), coefficient of variation, dipping pattern, and morning surge. Additional analyses were performed in patients with available data for arterial stiffness (pulse wave velocity [PWV], ankle-brachial index [ABI]) and cognitive function (Montreal Cognitive Assessment [MOCA]). Results: PPH was observed in 57 patients (47.1%). The mean postprandial systolic BP drop was 11.6±10.9 mmHg, with the largest decrease noted after dinner. Among those with PPH, 35 patients (61.4%) exhibited abnormal dipping patterns: non-dipper (28.1%), reverse dipper (15.8%), and extreme dipper (17.5%). Morning BP surge was more frequent in the PPH group (60.0% vs 39.3%, p=0.046). Daytime systolic BPV was significantly higher in PPH patients (18.2±5.9 vs 15.6±4.2 mmHg, p=0.027), while nocturnal BPV and diastolic BPV showed no significant differences. The degree of postprandial BP drop showed no significant correlation with nighttime dipping percent or other BPV indices. In subgroup analyses (PWV: n=101; MOCA: n=90), no significant associations were found between PPH or BPV and arterial stiffness or cognitive function parameters (all p>0.1). Conclusion: PPH is prevalent in T2DM patients and is associated with specific BPV patterns such as attenuated dipping and increased morning surge. However, the extent of BP drop is unrelated to nighttime dipping or other BPV measures and appears independent of arterial stiffness and cognitive status. These findings support the potential clinical significance of BPV-PPH interaction and warrant further longitudinal research.