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Frequency and Importance of Postprandial Blood Pressure Reduction in Elderly Nursing-Home Patients

Peter V. Vaitkevicius, MD; Donna M. Esserwein, RD; Andrea K. Maynard, BA; Frances C. O'Connor, BA; and Jerome L. Fleg, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by funds from the National Institute on Aging Training Grant in Geriatric Medicine (5T32AG00120-03). Andrea Maynard was supported by a grant from The John A. Hartford Foundation, Inc.

Requests for Reprints: Jerome L. Fleg, MD, Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, Francis Scott Key Medical Center, 4940 Eastern Avenue, Baltimore, Maryland 21224.

Current Author Addresses: Dr. Vaitkevicius: Division of Cardiology, School of Medicine, University of Maryland at Baltimore, 22 South Greene Street, Baltimore, Maryland 21201-1595.

Dr. Fleg and Ms. O'Connor: Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, 4940 Eastern Avenue, Baltimore, Maryland 21224.

Ms. Esserwein: Division of Nephrology, Frances Scott Key Medical Center, 4940 Eastern Avenue, Baltimore, Maryland 21224.

Ms. Maynard: Johns Hopkins University School of Medicine, 720 Rutland Ave, Baltimore, Maryland 21205.

Ann Intern Med. 1991;115(11):865-870. doi:10.7326/0003-4819-115-11-865
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Objective: To determine the frequency and importance of postprandial reductions in systolic blood pressure in debilitated, elderly patients receiving nursing home care.

Design: Cohort study.

Setting: Community-based, university-affiliated, teaching nursing home.

Patients: A total of 113 volunteer nursing-home residents with a mean (± SD) age of 78 ± 9 years; seven residents who refused the test meal served as controls.

Intervention: Participants had sequential blood pressure measurements for 90 minutes after the administration of a standardized meal.

Measurements and Main Results: Of 113 patients, 109 (96%) showed a postprandial reduction in systolic blood pressure (mean reduction, 17.9 ± 15.5 mm Hg) within 75 minutes; 41 patients (36%) had a reduction in systolic blood pressure of more than 20 mm Hg. Twelve patients (11%) had a reduction in systolic blood pressure to less than 100 mm Hg (mean systolic blood pressure, 88 ± 6.4 mm Hg); two of these patients became acutely symptomatic. Multiple regression analysis showed that higher premeal systolic blood pressure, a history of syncope, treatment with vasodilators, and dependent posture of the lower extremities during the postprandial period were all associated with a more severe postprandial decline in systolic blood pressure. Systolic blood pressure in noneating control subjects did not change during the same observation period. No significant differences in the mean systolic blood pressure nadir were found between the 14 patients who died during the follow-up period (mean follow-up, 6.1 ± 3.8 months) and those who survived.

Conclusion: Postprandial reductions in systolic blood pressure among elderly nursing-home patients are common, often large, and potentially symptomatic, but they do not generally presage subsequent intermediate-term mortality.





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