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Upright Posture and Postprandial Hypotension in Elderly Persons

Mathew S. Maurer, MD; Wahida Karmally, MS, RD, CDE; Harold Rivadeneira, BS; Michael K. Parides, PhD; and Daniel M. Bloomfield, MD
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Copyright ©2004 by the American College of Physicians

Ann Intern Med. 2000;133(7):533-536. doi:10.7326/0003-4819-133-7-200010030-00012
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Background: Syncope and falls are common in elderly persons and often result from the interaction of multiple clinical abnormalities. Both orthostatic hypotension and postprandial hypotension increase in prevalence with age.

Objective: To determine whether meal ingestion enhances orthostatic hypotension in elderly persons.

Design: Controlled paired comparison.

Setting: Clinical research center.

Patients: 50 functionally independent elderly persons recruited from local senior centers (n = 47) and from patients hospitalized with an unexplained fall or syncope (n = 3) (mean age, 78 years [range, 61 to 96 years]). Twenty-five participants (50%) were taking antihypertensive medication.

Measurements: Sequential head-up tilt-table testing at 60 degrees was performed before and 30 minutes after ingestion of a standardized warm liquid meal that was high in carbohydrates. Heart rate and blood pressure were continuously monitored.

Results: Meal ingestion (P < 0.01) and time spent upright (P < 0.001) were significantly associated with systolic blood pressure, but no significant interaction was found between meal ingestion and time spent upright (P > 0.2). These findings suggest that the association between meal ingestion and head-up tilt-table testing were additive and not synergistic. However, the proportion of participants with symptomatic hypotension increased during head-up tilt-table testing after meal ingestion (12% during preprandial testing and 22% during postprandial testing). Symptomatic hypotension tended to occur more often and sooner after meal ingestion than before meal ingestion (P = 0.03).

Conclusions: Meal ingestion and head-up tilt-table testing are associated with increasing occurrences of symptomatic hypotension. After meal ingestion and head-up tilt-table testing, 22% of functionally independent elderly persons had symptomatic hypotension.


Grahic Jump Location
Figure 1.
Average change in systolic blood pressure during preprandial (circles) and postprandial (squares) tilt-table testing in 50 study participants.PPP

The figure underestimates the associations of meal ingestion with decrease in blood pressure because participants in whom tilt-table testing was prematurely terminated as a result of severe hypotension are not included in the later stages of the tilt analysis. Associations were found between systolic blood pressure and time spent upright ( < 0.001) and meal ingestion ( < 0.01), but no interaction was found between meal ingestion and time spent upright ( > 0.2).

Grahic Jump Location
Grahic Jump Location
Figure 2.
Association between meal ingestion and time to symptomatic hypotension.

An increased percentage of the same participants had symptomatic hypotension after meal ingestion. The solid line represents preprandial data and the dotted line represents postprandial data. The percentage of participants with a positive result on tilt-table testing was higher after meal ingestion ( = 0.03).

Grahic Jump Location




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Summary for Patients

Blood Pressure in Older Adults after Meals and Standing Up

Copyright ©2004 by the American College of Physicians


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